• Introduction of non-transport guidelines into an ambulance service: a retrospective review

      Gray, J.T.; Wardrope, Jim (2007-10)
      Recent government policy has looked at improving the role of ambulance services in delivering alternative care models for patients. https://emj.bmj.com/content/24/10/727. 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.2007.048850
    • Severe hypoglycaemia in the community

      Scott, A.R.; Frampton, E. (2007-10-26)
    • Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial

      Mason, Suzanne; Knowles, Emma; Colwell, Brigitte; Dixon, Simon; Wardrope, Jim; Gorringe, Robert; Snooks, Helen; Perrin, Julie; Nicholl, Jon (2007-11)
      Objective To evaluate the benefits of paramedic practitioners assessing and, when possible, treating older people in the community after minor injury or illness. Paramedic practitioners have been trained with extended skills to assess, treat, and discharge older patients with minor acute conditions in the community. https://www.bmj.com/content/bmj/335/7626/919.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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmj.39343.649097.55
    • Avoiding admissions from the ambulance service: a review of elderly patients with falls and patients with breathing difficulties seen by emergency care practitioners in South Yorkshire

      Gray, J.T; Walker, A. (2008-02-25)
      To determine the true impact of emergency care practitioners (ECPs) on admissions relative to emergency department (ED) attendance. https://emj.bmj.com/content/25/3/168 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.2007.050732
    • AMPDS categories: are they an appropriate method to select cases for extended role ambulance practitioners?

      Gray, J.T.; Walker, A. (2008-09)
      To examine the correlation between the AMPDS prioritisation category at dispatch and the use of alternative clinical dispatch using data from an emergency care practitioner (ECP) service dispatching on likely clinical need. https://emj.bmj.com/content/25/9/601 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.2007.056184
    • Can emergency medical service staff predict the disposition of patients they are transporting?

      Clesham, K.; Mason, S.; Gray, J.; Walters, S.; Cooke, V. (2008-10-08)
      Emergency medical service (EMS) staff in the UK routinely transport all emergency responses to the nearest emergency department (ED). Proposed reforms in the ambulance service mean that EMS staff will transport patients not necessarily to the nearest hospital, but to one providing facilities that the patient is judged to require. No previous UK studies have evaluated how accurately EMS staff can predict which transported patients will require admission to hospital. https://emj.bmj.com/content/25/10/691 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.2007.054924
    • 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, Brigitte; 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
    • 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
    • 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
    • “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
    • Severe hypoglycaemia is a frequent reason for 999 calls in Yorkshire

      James, Cathryn; Scott, A. R.; Walker, Alison; Clapham, Linda (2010-03)
    • 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)
    • A Pilot Study of the Impact of NHS Patient Transportation on Older People with Dementia

      Roberts, Nicola; Curran, Stephen; Minogue, Virginia; Shewan, Jane; Spencer, Rebecca; Wattis, John (2010-06-14)
    • Clinical leadership in the ambulance service

      Walker, Alison; Sibson, Lynda; Marshall, Andrea (2010-06-18)
      Ambulance Services in England have recently launched the Report of the National Steering Group on Clinical Leadership in the Ambulance Service. This is the first document specifically reviewing the roles and development of Clinical Leadership, at all levels, for UK ambulance service clinicians. The document covers an evidence-based review of clinical leadership principles outlined in key policy documents, publications and systems; a strategic framework for clinical leadership in ambulance service; and includes examples of good current practice in ambulance service clinical leadership and development Clinical leadership has been referred to in a number of key policy documents; most notably, Taking Healthcare to the Patient: Transforming NHS Ambulance Services (DH 2005) made a number of recommendations of which Recommendation 62 is the most relevant to this document. “There should be improved opportunity for career progression, with scope for ambulance professionals to become clinical leaders. While ambulance trusts will always need clinical direction from a variety of specialties, they should develop the potential of their own staff to influence clinical developments and improve and assure quality of care.” This report focuses on putting theory into practice, a proposed clinical leadership ladder and a clinical leadership self-assessment tool for individuals and organisations. Some clinical leadership examples are also included. The completed report was formally launched at the Ambulance Leadership Forum (English ambulance services, with participation for Clinical Leadership from the other UK ambulance services) in April 2009 and will pave the way for the development of the Ambulance Service National Future Clinical Leaders Group. This national pilot, involving all the UK NHS ambulance services, will comprise of staff with paramedic backgrounds who will receive leadership development to work with the CEOs and Directors of Clinical Care groups to progress clinical quality and clinical leadership development in the ambulance service. https://emj.bmj.com/content/27/6/490.2. 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/emj.2009.078915
    • Medical and prehospital care training in UK fire and rescue services

      Walker, Alison; Robson, Brian (2010-12)
      We were interested to see the paper by Quinn et al1 in this month's EMJ. We undertook a similar survey published in the EMJ in 2005 on the Fire Service management of burns,2 which concentrated on burns but also reviewed general levels of clinical training and skills within the Fire and Rescue Services (FRS), also with a response rate of over 70%. At the time 44/62 services had trained all their firefighters in the delivery of supplementary oxygen (71%), and it seems in some areas there is little change in skills, as in this paper 72% of responding services trained firefighters to provide supplementary oxygen. We also found similar levels of involvement in clinical training from both local hospitals and other prehospital organisations including NHS Ambulance Trusts. Since the publication of both our paper and that of Lee and Porter3 in 2007, the UK FRS through the Chief Fire Officers Association (CFOA) have been working to standardise prehospital immediate care provided by UK firefighters. This work has been looking at ways to develop a minimum standard of knowledge and application that satisfies the demanding requirements of both the FRS and the Health and Safety Executive. A further area for development has been in considering effective Clinical Governance systems; an area which the FRS has had little previous involvement. The work has recently been given project status by the Department for Communities and Local Government (CLG), the government department responsible for the FRS. In London, excellent results have been seen in a pilot project (Immediate Emergency Care), in which the London Fire Brigade (LFB) have worked closely with London Ambulance Service (LAS) in all aspects of the delivery of training, operational and clinical governance policies and procedures, and shared equipment protocols. The pilot is now being rolled out to all operational staff across LFB and has been made available to other regions as a working model. It is widely accepted that the natural partners for the FRS are NHS Ambulance Trusts. The main objective of the CLG project is to consider whether the progress made in London can be duplicated across the UK, reducing the requirement for FRS to rely on commercially driven or locally produced training. Initial indications suggest that this can be delivered. The Faculty of Prehospital Care has also supported developments in FRS Immediate Care. In summary, a great deal of work has already been completed, with more in development, around immediate emergency care by the UK Fire and Rescue Services. https://emj.bmj.com/content/27/12/960.2. 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/emj.2009.081828
    • 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. (2010-12)
      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/emermed/27/12/943.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.2009.072959
    • 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.
    • 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)
    • 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.