Publications from the Yorkshire Ambulance Service. To find out more about YAS visit their website at https://www.yas.nhs.uk

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  • 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.
  • Does the pandemic medical early warning score system correlate with disposition decisions made at patient contact by emergency care practitioners?

    Gray, J.T.; Challen, K; Oughton, L (2010-11-13)
    Objective To assess the performance of the pandemic medical early warning score (PMEWS) in a cohort of adult patients seen in the community by emergency care practitioners (ECP) and its correlation with ECP decision-making to either ‘treat and leave’ or transfer for hospital assessment. Methods Cases attended by ECP in South Yorkshire in 2007 in which the final ECP working diagnosis was a respiratory condition were retrospectively identified from the Yorkshire Ambulance Service database. The patient report forms were reviewed for the PMEWS variables and scores calculated using the PMEWS system. The outcome measure was management in the community versus transport to hospital. Receiver operating characteristics (ROC) curves were calculated to assess the discrimination of PMEWS. Results A cohort of 300 patients was assessed. 217 (72%) were aged 65 years or over, and 272 (91%) had either comorbid disease or impaired functional status. 98 (33%) were deemed to need hospital assessment or admission. The ROC curves suggested that there is good correlation between the PMEWS score and the decision to discharge. Conclusions PMEWS correlates well with decisions to admit to hospital or leave at home made by extended role practitioners in the patient group studied; however, further prospective work is required to further validate early warning scoring systems in prehospital care. https://emj.bmj.com/content/27/12/943 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/ http://dx.doi.org/10.1136/emj.2011.113019
  • Mobile Radiography at a Music Festival

    Walker, A.; Brenchley, J.; Hughes, N. (2009-07-22)
    Limb injuries are common at music festival sites and traditionally patients seen by on-site medical services require referral to hospital emergency departments for radiographic exclusion of bony injury. This takes clinical personnel off site, increases demand on local emergency departments and is inconvenient for revellers. This is an audit of the use of a portable digital radiography system at the Virgin music festival in Staffordshire over a 3-year period. https://emj.bmj.com/content/26/8/613. 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.2008.059006
  • Is referral to emergency care practitioners by general practitioners in-hours effective?

    Gray, J.T.; Walker, A. (2009-07-22)
    Objective: To evaluate the cost effectiveness to primary care trusts (PCT) in commissioning general practitioner (GP) referrals in-hours to emergency care practitioners (ECP). Methods: A retrospective case note review for patients referred by GPs in-hours to ECP over a 4-month period to ascertain any added value over a GP visit. Results: In a 4-month period 105 patients were referred. In most cases (90.5%) the ECP was utilised as a substitute for a GP rather than providing any additional skills. Defining an avoided attendance as the ECP undertaking an intervention outside a GP skill set this equated to a 9.5% avoided attendance rate compared with the ECP service standard rate of 60%. This has implications both in terms of financial benefit and ongoing ECP service sustainability. Conclusions: There is little value in a PCT commissioning this service as they will pay twice and care must be taken in accepting new referral streams into existing services. https://emj.bmj.com/content/26/8/611. 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.2008.059956
  • “At the sharp end”: does ambulance dispatch data from south Yorkshire support the picture of increased weapon-related violence in the UK?

    Gray, J.T.; Walker, A. (2009-09-22)
    Objective: To assess whether ambulance responses in South Yorkshire to stabbing, gunshot, penetrating trauma cases have increased over the past few years, supporting the observed increase in media reporting. Methods: A review was undertaken of the frequency with which the ambulance medical priority dispatch system card 27 (stab/gunshot/penetrating trauma) was used, grouped by financial year, and comparison made over time and by patient age group. Results: There is a steady increase in the number of occurrences of these cases and also an increase in the percentage made up by the 10–29 year age group. Conclusions: Ambulance data from South Yorkshire support the media conclusion that there is an increase in stabbing, gunshot and penetrating trauma as well as an increase in the proportion of younger victims. This has wider implications for ambulance staff and the UK as a whole; however, these calls remain a low percentage of overall ambulance service activity. https://emj.bmj.com/content/26/10/741. 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.2008.067298
  • Characteristics of people from Leeds with severe hypoglycaemia requiring emergency services intervention in the home

    james, cathryn; Scott, A. R.; Walker, Alison; Ajjan, Ramzi A.; Clapham, Linda (2010-03)
  • Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial

    Dixon, S.; Mason, Suzanne; Knowles, Emma; Colwell, B.; Wardrope, Jim; Snooks, Helen; Gorringe, R.; Perrin, J.; Nicholl, Jon (2009-05-22)
    Background: A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK. Objectives: To assess the cost effectiveness of the paramedic practitioner (PP) scheme compared with usual emergency care. Methods: A cluster randomised controlled trial was undertaken of PP compared with usual care. Weeks were allocated to the study group at random to the PP scheme either being active (intervention) or inactive (control). Resource use data were collected from routine sources, and from patient-completed questionnaires for events up to 28 days. EQ-5D data were also collected at 28 days. Results: Whereas the intervention group received more PP contact time, it reduced the proportion of emergency department (ED) attendances (53.3% vs 84.0%) and time in the ED (126.6 vs 211.3 minutes). There was also some evidence of increased use of health services in the days following the incident for patients in the intervention group. Overall, total costs in the intervention group were £140 lower when routine data were considered (p = 0.63). When the costs and QALY were considered simultaneously, PP had a greater than 95% chance of being cost effective at £20 000 per QALY. Conclusion: Several changes in resource use are associated with the use of PP. Given these economic results in tandem with the clinical, operational and patient-related benefits, the wider implementation and evaluation of similar schemes should be considered. https://emj.bmj.com/content/26/6/446. 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.2008.061424
  • A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

    Platt, Anthony (2020-06-01)
    Background: In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology. Methods: All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data. Results: 478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%). Conclusion: Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival. Abstract published with permission.
  • The role of ambulance clinicians in management and leadership

    Taylor, James (2011-01)
    Abstract published with permission. Ambulance clinicians are ‘professional problem solvers’. As such, they share much in common with managers within organizations, and have much to offer in terms of the contribution that they can make to the management and leadership of the organisations within which they work. This article highlights the importance of management and leadership development opportunities being made available for ambulance clinicians. A practical approach is advocated, whereby ‘hybrid roles’ are developed to enable individuals to gain practical experience of management and leadership within a structured and supportive environment, while retaining an element of clinical practice. A case study is used to illustrate the article, based upon the author's own career within the NHS to date which has combined both management and clinical practice with structured management and leadership development. Practical advice is offered for those ambulance clinicians who may be interested in undertaking such development in future, or who wish to explore further their role as clinical leaders.
  • Suicide among ambulance service staff: a review of coroner and employment records

    Mars, Becky; Hird, Kelly; Bell, Fiona; James, Cathryn; Gunnell, David (2020-03-01)
  • Improving post-resuscitation care after out-of-hospital cardiac arrest

    Fisher, Ruth (2020-01)
    Abstract published with permission. Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres. Methods: Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes. Results: Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur. Conclusion: Further research into specific care pathways and centralised care should be carried out, and an OHCA postresuscitation care pathway should be developed to improve the delivery of care and survival.
  • Elderly falls: a national survey of UK ambulance services

    Darnell, Gareth; Mason, Suzanne; Snooks, Helen (2012-12-29)
    Objective To provide a detailed description of the current UK ambulance service provision for older people who fall. Method National survey of UK ambulance services. Results 11/13 Ambulance services (84.6%) participated in this national survey. Conclusion This survey has highlighted the need for robust evidence to inform policy, service and practice development to improve the care of this vulnerable population. https://emj.bmj.com/content/29/12/1009 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/bmj.h535
  • A mannequin study comparing suitability of the i-gel™ with a laryngeal mask airway device

    Mark, Julian; Walker, Alison; Davey, Christine (2011-08)
    Abstract published with permission. Objectives: To compare the suitability of the i-gel™ (Intersurgical Ltd, UK) supraglottic airway device with a single-use laryngeal mask airway (LMA) in the hazardous area response team (HART) environment and the urban search and rescue (USAR) environment. Method: five chemical, biological, radiological and nuclear trained urban search and rescue paramedics attempted five insertions of each supraglottic airway device into a Laerdal® ALS mannequin (Laerdal, Norway) in three separate environments: normal (supine, waist high), HART (wearing gas-tight suits and respirators) and USAR (in a simulated confined space). As a control group, five anaesthetists also attempted five insertions of each supraglottic airway device into a Laerdal® Airway Trainer (Laerdal, Norway) under normal conditions. Time from first touching the device to successful inflation of the mannequin's lungs’ using a self-inflating bag-valve device was recorded and operator opinion was captured using a four-point Likert scale. Results: insertion of the i-gel airway was significantly faster than insertion of the LMA in simulated USAR conditions (P<0.001), there was no significant difference in control conditions or when wearing gas-tight personal protective equipment. There was no difference in the number of attempts required to achieve correct placement of either supraglottic airway device in any situation. Conclusions: this study has demonstrated that, in simulated USAR conditions, the i-gel supraglottic airway device performs at least as well as the LMA and is significantly quicker to insert. The authors therefore recommend that the i-gel is introduced into the USAR HART environment with further clinical evaluation in this and other prehospital settings.
  • National swine flu adult assessment guidelines: retrospective validation of objective criteria in three proxy datasets

    Challen, K.; Bentley, A.; Bright, J.; Gray, J.; Walter, D. (2011-04)
    OBJECTIVES: To validate the objective criteria in the Department of Health Adult Swine Flu Assessment Tool against proxy datasets for pandemic influenza. DESIGN: Comparative validation study with 3 datasets. SETTING: Urban Emergency Department (group 1) and prehospital care (groups 2 and 3). PARTICIPANTS: Adults with community-acquired pneumonia (group 1, n=281), shortness of breath (group 2, n=211) or any respiratory diagnosis (group 3, n=300). OUTCOME MEASURES: Hospital admission (group 1), hospital admission or intravenous therapy (group 2) and transfer to emergency department (group 3). RESULTS: Sensitivity and specificity of the tool were 0.73 (95% CI 0.67 to 0.8) and 0.83 (0.72 to 0.9) in group 1, 0.64 (0.55 to 0.71) and 0.63 (0.52 to 0.73) in group 2 and 0.84 (0.75 to 0.9) and 0.55 (0.48 to 0.62) in group 3. Analysis of individual components of the tool and a summative score is presented. CONCLUSIONS: The objective criteria of the proposed DH assessment tool do not perform particularly well in predicting relevant clinical outcomes in feasible proxy conditions for pandemic influenza. https://emj.bmj.com/content/emermed/28/4/287.full.pdf 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/ http://dx.doi.org/10.1136/emj.2009.083683
  • The A2Z of Immediate Care

    Walker, Alison (2011-08)
  • Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes

    Snaith, B.; Hardy, M.; Walker, Alison (2011-12)
    This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED. https://emj.bmj.com/content/emermed/28/12/1063.full.pdf 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/ http://dx.doi.org/10.1136/emj.2010.096966

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