• The A2Z of Immediate Care

      Walker, Alison (2011-08)
    • The acceptability and safety of video triage for ambulance service patients and clinicians during the COVID-19 pandemic

      Bell, Fiona; Pilbury, Richard; Connell, Rob; Fletcher, Dean; Leatherland, Tracy; Cottrell, Linda; Webster, Peter (2021-09)
      In response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust introduced video technology to supplement remote triage and 'hear and treat' consultations as a pilot project in the EOC. We conducted a service evaluation with the aim of investigating patient and staff acceptability of video triage, and the safety of the decision-making process. Abstract published with permission.
    • Addressing the challenges of paramedic recruitment and engagement in AIRWAYS-2

      Pilbery, Richard; Green, Jonathan; Hall, Helen; Whitley, Gregory (2016-09)
      AIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). Four NHS ambulance trusts are taking part in AIRWAYS-2: East Midlands, South Western, Yorkshire and East of England. One of the key challenges has been the need to recruit approximately 1300 study paramedics for the trial. The three main challenges in engaging and recruiting paramedics to participate in AIRWAYS-2 have been: ▸ Concerns relating to the potential results of the trial and what this will mean for the continuation of intubation for paramedics ▸ Concerns relating to the restriction on paramedic choice of advanced airway in OHCA and potential skill erosion ▸ Provision of training over large geographical areas at a time when morale is low and many ambulance trusts have recruitment and retention issues. How have these challenges been overcome? ▸ Communication: Identifying the most appropriate communication methods in each Trust e.g. face to face, email, internal trust operational updates ▸ Delivery of key messages: Emphasising why the trial is important and needed, and that its goal is not to remove intubation from paramedic practice. Obtaining the engagement of senior operational management to allay fears over impacts on service performance ▸ Valuing study paramedics: Paying clinicians overtime to attend training sessions, which contributes to their own continuing professional development ▸ Equity and opportunity: Delivery of multiple training sessions throughout each of the four ambulance trusts. Key achievements By November 2015, research paramedics had delivered nearly 350 training sessions and recruited in excess of 1300 paramedics to AIRWAYS-2. Conclusion The research paramedics leading AIRWAYS-2 have collaboratively, and successfully, overcome the main challenges relating to recruiting and engaging the paramedics in their Trusts. This should contribute to achieving the target patient sample size for the trial. https://emj.bmj.com/content/emermed/33/9/e12.1.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/emermed-2016-206139.38
    • Aerodynamic Drag Reduction of Emergency Response Vehicles

      Taherkhani, A.R.; deBoer, G.N.; Gaskell, P.H.; Gilkeson, C.A.; Hewson, R.W.; Keech, A.; Thompson, H.M.; Toropov, V.V. (2015-09-30)
    • An alternative care pathway for suspected seizures in pre-hospital care: a service evaluation

      Dickson, Jon M.; Rawlings, Gregg H.; Grünewald, Richard A.; Miles, Kate; Mack, Carina; Heywood, Thomas; Reuber, Markus (2017-09)
      Abstract published with permission. Introduction ‐ An uncomplicated, self-limiting epileptic seizure in a patient with an established diagnosis of epilepsy usually requires only first aid, but in the UK it is estimated that 75% of these patients are transported to hospital and many are discharged without review or follow-up with an epilepsy specialist. Alternative care pathways have the potential to reduce unnecessary conveyance to hospital and to improve rates of epilepsy specialist follow-up, and thereby increase the quality and cost effectiveness of care. Methods ‐ A service evaluation of a new alternative care pathway in a regional ambulance service in the UK. The alternative care pathway allowed paramedics to refer eligible patients to an epilepsy specialist nurse service. Results ‐ The ambulance service managed 3964 suspected seizure incidents in the study period (1 July 2015‐31 May 2016), of which 22.5% (891/3964) were potentially eligible for the alternative care pathway. Of the potentially eligible incidents, 9.8% (87/891) were referred. The 87 incidents were generated by 74 individual patients. A total of 97.3% (71/73) patients were contacted within the target time of five days, the average time taken for each phone call was 10 minutes and the average additional work load generated by each call was 10 minutes. There was a positive outcome in 55% (48/87) of incidents. Conclusions ‐ An alternative care pathway for people after a suspected seizure has the potential to safely reduce rates of transport to hospital and to improve care for people with epilepsy. However, paramedics in our study used the alternative care pathway for only a small proportion of those patients who were potentially eligible. Further research is required to develop tools to support paramedics to confidently identify patients that are suitable for management without transport to hospital.
    • Ambulance over-conveyance to the emergency department: a large data analysis of ambulance journeys

      Miles, Jamie; O'Keefe, Colin; Jacques, Richard; Stone, Tony; Mason, Suzanne (2018-04-16)
      Over-conveyance by the ambulance service is a compounding factor of emergency department (ED) crowding. Previous solutions have focused on specific patient groups which have a limited impact when compared to the whole urgent and emergency care system. This study aims to analyse non-urgent conveyances by the ambulance service that could be suitable for discharge on-scene. https://bmjopen.bmj.com/content/8/Suppl_1/A22.3. 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/bmjopen-2018-EMS.59
    • Ambulance over-conveyance to the emergency department: a large data analysis of ambulance journeys

      Miles, J.; O'Keeffe, C.; Jacques, Richard; Stone, Tony; Mason, Suzanne (2018-04)
      Aim Over-conveyance by the ambulance service is a compounding factor of emergency department (ED) crowding. Previous solutions have focused on specific patient groups which have a limited impact when compared to the whole urgent and emergency care system. This study aims to analyse nonurgent conveyances by the ambulance service that could be suitable for discharge on-scene. Results We analysed a dataset of 1,312,539 patient episodes which linked all pre-hospital emergency and urgent calls to subsequent ED attendance in 2014. The study was set in a large region in England (total population 5.3 million). As well as proportion of avoidable conveyances we also examined the association with patient age, time of arrival, re-attendance and initial triage code from ambulance dispatch. Results There were 4 04 348 (30.8%) patients transported to ED by ambulance and of these 66 220 (16.4%) were considered potentially avoidable. There were significantly increased odds of a non-urgent conveyance out of hours (OR 1.44, 95% CI: 1.41 to 1.46). Patients aged 16–34 had the largest proportion of avoidable conveyances with 24 500 (37%). There were 13 625 (21%) episodes that were received from another healthcare professional or urgent telephone number. When analysing ED diagnosis, the highest proportion were attending with minor injury and illness, and alcohol intoxication. Abstracts A22 BMJ Open 2018;8(Suppl 1):A1–A34 Trust (NHS). Protected by copyright. on 14 August 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.59 on 16 April 2018. Downloaded from Conclusion One in six ambulance conveyances to ED were deemed non-urgent. The younger population had the largest amount of preventable conveyance by ambulance with diagnoses which could be treated and discharged on-scene. Pathways and interventions would provide a larger patient benefit if they were designed around patient populations as opposed to disease specific https://bmjopen.bmj.com/content/8/Suppl_1/A22.3 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/bmjopen-2018-EMS.59
    • Ambulance-delivered transdermal glyceryl trinitrate versus sham for ultra-acute stroke: Rationale, design and protocol for the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) trial (ISRCTN26986053)

      Appleton, Jason P.; Scutt, Polly; Dixon, Mark; Howard, Harriet; Haywood, Lee; Havard, Diane; Hepburn, Trish; England, Timothy J.; Sprigg, Nikola; Woodhouse, Lisa J.; et al. (2017-08-01)
    • 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
    • “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
    • 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
    • Awareness of CPR-induced consciousness by UK paramedics

      Mays, Ben; Gregory, Pete; Sudron, Ceri; Kilner, Tim (2019-06-01)
    • Bypassing nearest hospital for more distant neuroscience care in head-injured adults with suspected traumatic brain injury: findings of the head injury transportation straight to neurosurgery (HITS-NS) pilot cluster randomised trial

      Lecky, Fiona E.; Russell, Wanda; McClelland, Graham; Pennington, Elspeth; Fuller, Gordon W.; Goodacre, Steve; Han, Kyee; Curran, Andrew; Holliman, Damian; Chapman, Nathan; et al. (2017-10)
      Objective Reconfiguration of trauma services, with direct transport of patients with traumatic brain injury (TBI) to specialist neuroscience centres (SNCs)— bypassing non-specialist acute hospitals (NSAHs), could improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) may worsen outcomes when compared with selective secondary transfer from nearest NSAH to SNC. We conducted a pilot cluster randomised controlled trial to determine the feasibility and plausibility of bypassing suspected patients with TBI —directly into SNCs—producing a measurable effect. Setting Two English Ambulance Services. Participants 74 clusters (ambulance stations) were randomised within pairs after matching for important characteristics. Clusters enrolled head-injured adults— injured nearest to an NSAH—with internationally accepted TBI risk factors and stable ABC. We excluded participants attended by Helicopter Emergency Medical Services or who were injured more than 1 hour by road from nearest SNC. Interventions Intervention cluster participants were transported directly to an SNC bypassing nearest NSAH; control cluster participants were transported to nearest NSAH with selective secondary transfer to SNC. Outcomes Trial recruitment rate (target n=700 per annum) and percentage with TBI on CT scan (target 80%) were the primary feasibility outcomes. 30-day mortality, 6-month Extended Glasgow Outcome Scale and quality of life were secondary outcomes. Results 56 ambulance station clusters recruited 293 patients in 12 months. The trial arms were similar in terms of age, conscious level and injury severity. Less than 25% of recruited patients had TBI on CT (n=70) with 7% (n=20) requiring neurosurgery. Complete case analysis showed similar 30-day mortality in the two trial arms (control=8.8 (2.7–14.0)% vs intervention=9.4(2.3–14.0)%). Conclusion Bypassing patients with suspected TBI to SNCs gives an overtriage (false positive) ratio of 13:1 for neurosurgical intervention and 4:1 for TBI. A measurable effect from a full trial of early neuroscience care following bypass is therefore unlikely https://bmjopen.bmj.com/content/bmjopen/7/10/e016355.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/bmjopen-2017-016355
    • Bystander cardiopulmonary resuscitation: Impact of training initiatives

      Brown, Terry P.; Booth, Scott; Lockey, Andrew S.; Askew, Sara; Hawkes, Claire A.; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Gunson, Imogen; Soar, Jasmeet; et al. (2018-09)
    • 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
    • Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Soar, Jasmeet; Mark, Julian; Mapstone, James; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Bichmann, Anna; et al. (2019-01-01)
    • 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)