Now showing items 21-40 of 161

    • A comparison of biphasic manual and semi-automatic external defibrillation

      Smith, Neil; Moat, Chris; Neoptolemos, Ptolemy (2023-06-02)
      Background: Biphasic manual defibrillation (MD) is advocated as the preferred strategy for paramedics ahead of semi-automatic external defibrillation (SAED) for out-of-hospital cardiac arrest (OHCA). Methods: A systematic review involved searching CINAHL, MEDLINE and Embase academic databases. Comparative studies where both strategies were tested for time to first defibrillation (TTFD) and related Utstein-based model outcomes were examined to discern which strategy was superior. Results: Two studies met the criteria. One study found that in 4552 SAED episodes of defibrillation (30.8% of the 14 776 total defibrillation episodes), a decrease of >10% in mean TTFD (P<0.001) of an intial shockable rhythm was recorded. The same study reported an overall decrease in TTFD within 2 minutes (95% CI/P<0.001), with a 68% improved odds of receiving a shock within two minutes. SAED was associated with a 26% reduction in the risk-adjusted odds of survival (95% CI/P<0.009), attributed to cardiopulmonary resuscitation (CPR) delays. The other examined 160 defibrillations in OHCA. The MD median TTFD was 7 seconds faster (95% CI/P<0.0001) and responsible for 20% more inappropriate shocks. Conclusions: Modern SAED is superior in reducing TTFD and inappropriate shocks. The modern SAED and MD strategies can be enhanced by interruption-reducing technology. New SAED algorithms can detect shockable rhythms in 3 seconds. More randomised studies need to be conducted using up-to-date devices. A multifaceted approach incorporating technological advancements, ongoing research and training is necessary to ensure that the most effective defibrillation strategy is employed. Abstract published with permission
    • Which patients should be pre-alerted? A review of UK ambulance service guidelines

      Boyd, Aimee; Sampson, Fiona; Pilbury, Richard; Bell, Fiona; Millins, Mark; Coster, Joanne; Rosser, Andy; Spaight, Robert
    • The age of artificial intelligence

      Frankland, Joe; Mulrooney, Will; Crosland, Charles; Macmillan, Jack (2023-05-02)
      rtificial intelligence (AI) is gradually integrating into various sectors such as finance, transportation, energy and education. Although AI is in its infancy in healthcare, it is still being used in many ways, including medical imaging, chatbots, diagnosis, treatment, and telephone triage in an ambulance setting. The introduction of AI has given rise to ethical concerns—particularly about how data are gathered and used (Gerke et al, 2020). The key attributes of AI are its ability to analyse and compare vast datasets and predict likely outcomes, hence its integration into patient triage and assessment systems. To achieve genuine impartiality and autonomy in the realm of AI, datasets utilised by such systems must possess analogous qualities (González-Gonzalo et al, 2022). Norori et al (2021) highlight statistical and social bias within healthcare datasets. Abstract published with permission.
    • Demystifying prehospital research in practice

      Wilson, Caitlin (2023-05-02)
      It is not every day you are asked to review a book written by esteemed colleagues and friends—but here I am. In this month's book review, I am reviewing Prehospital Research Methods and Practice, edited by Professor Niro Siriwardena and Dr Greg Whitley. The two editors are of course well-known experts in prehospital research, with the list of authors including paramedic researchers and experienced academics mainly from across the UK, but also including colleagues from Australia and the United States. Abstract published with permission.
    • 'Every day was a learning curve': Implementing Covid-19 triage protocols

      Porter, A; Bell, F; Brady, M; Brown, S; Carson-Stevens, A; Duncan, E; England, L; Evans, B; Foster, T; Gallanders, J; et al.
      Background TRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic's first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols. Method Research paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants' accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together. Results We identified the following themes: Constantly changing guidelines - at some points, updated several times a day. The ambulance service as part of the wider healthcare system - changes elsewhere in the system left ambulance services as the default. Peaks and troughs of demand - fluctuating greatly over time, and varying across the staff groups. A stretched system - resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED. Emotional load of responding to the pandemic - including call centre staff. Doing the best they can in the face of uncertainty - a rapidly evolving situation unlike any which ambulance services had faced before. Conclusion Implementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load. https://bmjopen.bmj.com/content/12/Suppl_1/A16.1 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/openhrt-2015-000281
    • Burnout in frontline ambulance staff

      Beldon, Rachel; Garside, Joanne (MAG Online, 2022-01-02)
      Background: Staff retention is a significant issue for ambulance services across the globe. Exploratory research, although minimal, indicates that stress and burnout, in particular, influence attrition within the paramedic profession. These need to be understood if their impact on retention is to be addressed. Aims: To determine the presence of and contributory factors for burnout in the ambulance service to inform recommendations for positive change. Methods: A two-phased survey approach was adopted using an adapted Maslach Burnout Inventory and Copenhagen self-assessment burnout questionnaire, to measure levels of burnout, depersonalisation (cynicism) and personal achievement. Open-ended questions explored factors that influenced these. Demographic and comparative analysis identified trends and thematic analysis was carried out on the qualitative data. Results: Ninety-four per cent of ambulance staff in this study (n=382) reported a sense of personal achievement within their professional role; however, more than 50% were experiencing varying levels of burnout with 87% displaying moderate or high levels of depersonalisation towards their work. Causes of stress were complex: themes attributed were a perceived lack of management support, the public's misuse of the ambulance service, involuntary overtime and a poor work-life balance. Conclusions: Burnout poses a genuine threat to retention in the ambulance service and needs addressing. Proactive screening, better communication between practice staff and management and access to counselling services are recommended. This problem of burnout is beginning to be acknowledged but further evidence is needed to understand it in more depth in order for effective solutions to be developed. Abstract published with permission
    • Chest compressions and defibrillation as aerosolgenerating procedures

      Millington, Timothy Ian; Chilcott, Robert P.; Williams, Julia (2023-04-02)
      SARS-CoV-2 is a highly contagious respiratory pathogen associated with significant mortality in certain patient populations. Patients may be asymptomatic, which causes problems regarding infection control and prevention. Health professionals are required to adhere to strict protocols regarding infection control and personal protective equipment (PPE), particularly when engaging in resuscitation activities thought to be aerosol-generating procedures (AGPs). While adherence to enhanced PPE protocols can delay life saving interventions, non-adherence may put responders at risk. The aim of this scoping literature review was to establish if chest compressions and defibrillation should be classified as AGPs. Following application of systematic literature search criteria, a limited selection of studies was identified in relation to chest compressions and defibrillation as AGPs. An assumption that endotracheal intubation posed a high risk of nosocomial transmission was noted. Emerging evidence suggests that endotracheal intubation produces fewer aerosol particles than coughing so could be classed as a low-risk-procedure. Because of the lack of adequate prospective studies investigating chest compressions and defibrillation as AGPs, there is a clear need to perform further, well-controlled studies to better understand the aerosol-generating potential of chest compressions and defibrillation. Abstract published with permission.
    • Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study

      Marincowitz, Carl; Stone, Tony; Bath, Peter; Campbell, Richard; Turner, Janette Kay; Hasan, Madina; Pilbery, Richard; Thomas, Benjamin David; Sutton, Laura; Bell, Fiona; et al.
      OBJECTIVE: To assess accuracy of telephone triage in identifying need for emergency care among those with suspected COVID-19 infection and identify factors which affect triage accuracy. DESIGN: Observational cohort study. SETTING: Community telephone triage provided in the UK by Yorkshire Ambulance Service NHS Trust (YAS). PARTICIPANTS: 40 261 adults who contacted National Health Service (NHS) 111 telephone triage services provided by YAS between 18 March 2020 and 29 June 2020 with symptoms indicating COVID-19 infection were linked to Office for National Statistics death registrations and healthcare data collected by NHS Digital. https://qualitysafety.bmj.com/content/early/2022/03/29/bmjqs-2021-014382 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/bmjqs-2021-014382
    • The experiences and perceptions of wellbeing provision among English ambulance services staff: a multi-method qualitative study

      Phung, Viet-Hai; Sanderson, Kristy; Pritchard, Gary; Bell, Fiona; Hird, Kelly; Wankhade, Paresh; Asghar, Zahid; Siriwardena, Aloysius
    • Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study

      Marincowitz, Carl; Sutton, Laura; Stone, Tony; Pilbery, Richard; Campbell, Richard; Thomas, Benjamin David; Turner, Janette; Bath, Peter A.; Bell, Fiona; Biggs, Katie; et al. (2022-04)
      Tools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compared accuracy to existing clinical decision making in a prehospital setting. https://emj.bmj.com/content/39/4/317.long 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/emermed-2021-211934
    • Beyond hype to reality

      Zaroof, Nagina (2023-01-02)
      In her first bimonthly column, Nagina Zaroof reflects on her expectactations as a student versus the reality of practising as a newly qualified paramedic (NQP). Abstract published with permission.
    • Lifting the rug…

      Zaroof, Nagina (2023-03-02)
      At university and on placements, I learned a great deal about how to communicate with patients and the general public. Soon enough, however, you realise that your encounters with 'real patients' are maybe not as smooth as you would hope. Abstract published with permission.
    • Evaluation of pre-hospital COVID-19 rapid antigen tests by paramedics and their use in a direct admission pathway

      Richards, Alexander; Muddassir, Muhammad; Sampson, Fiona; MacLachlan, Laura; Miller, Elisha; Fitchett, Joseph; Bell, Fiona; Ivan, Monica; Lillie, Patrick; Samson, Anda; et al. (2022-09)
    • The effect of a specialist paramedic primary care rotation on appropriate non-conveyance decisions (SPRAINED) study: a controlled interrupted time series analysis

      Pilbery, Richard; Young, Tracey; Hodge, Andrew (2022-06-01)
      NHS ambulance service non-conveyance rates in the United Kingdom are around 30%, despite an increase in non-emergency cases and a national policy of integrating urgent and emergency care to provide patients with the ‘right care, in the right place, at the right time’. Emergency department overcrowding is a significant issue for patients, resulting in poorer quality of care, increased healthcare costs and potentially, increased mortality. It also contributes to increased ambulance turnaround times. Yorkshire Ambulance Service NHS Trust (YAS) introduced a specialist paramedic (SP) to improve the management of lower acuity cases, but non-conveyance rates in this group have not been as high as expected. In 2018, Health Education England funded a pilot scheme to rotate paramedics into a range of healthcare settings and in YAS, 10 SPs undertook a 10-week placement in a GP practice. This study aimed to evaluate whether a primary care placement appropriately increased the level and trend of non-conveyance decisions made by SPs following a 10-week GP placement, in a cost-effective manner. Methods: We conducted a controlled interrupted time series analysis using data from incidents between 1 June 2017 and 31 December 2019, to study appropriate non-conveyance rates before and after a GP placement. A costing analysis, examining the average cost per appropriate non-conveyance achieved for patients receiving care from intervention group SPs pre- and post-placement, was also conducted. Results: A total of 7349 incidents attended by intervention group SPs were eligible for inclusion. Following removal of cases with missing data, 5537 (75.3%) cases remained. Post-placement. Abstract published with permission.
    • A qualitative analysis of stressors affecting 999 ambulance call handlers’ mental health and well-being

      Powell, Catherine; Fylan, Beth; Lord, Kathryn; Bell, Fiona; Breen, Liz (2022-09-28)
    • Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study

      Marincowitz, Carl; Stone, Tony; Hasan, Madina; Campbell, Richard; Bath, Peter A.; Turner, Janette; Pilbery, Richard; Thomas, Benjamin David; Sutton, Laura; Bell, Fiona; et al. (2022-05)
      Objective - To assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy. Design - Observational cohort study. Setting - Emergency telephone triage provided by Yorkshire Ambulance Service (YAS) National Health Service (NHS) Trust. Participants - 12 653 adults who contacted EMS telephone triage services provided by YAS between 2 April 2020 and 29 June 2020 assessed by COVID-19 telephone triage pathways were included. Outcome - Accuracy of call handler decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from first contact with the telephone triage service. Results - Callers contacting EMS dispatch services had an 11.1% (1405/12 653) risk of death or needing organ support. In total, 2000/12 653 (16%) of callers did not receive an emergency response and they had a 70/2000 (3.5%) risk of death or organ support. Ambulances were dispatched to 4230 callers (33.4%) who were not conveyed to hospital and did not deteriorate. Multivariable modelling found variables of older age (1 year increase, OR: 1.05, 95% CI: 1.04 to 1.05) and presence of pre existing respiratory disease (OR: 1.35, 95% CI: 1.13 to 1.60) to be predictors of false positive triage. Conclusion - Telephone triage can reduce ambulance responses but, with low specificity. A small but significant proportion of patients who do not receive an initial emergency response deteriorated. Research to improve accuracy of EMS telephone triage is needed and, due to limitations of routinely collected data, this is likely to require prospective data collection. https://bmjopen.bmj.com/content/12/5/e058628. 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. https://creativecommons.org/licenses/by-nc/4.0/
    • In a simulated adult trauma patient, can pelvic binders be applied accurately by paramedics and HEMS paramedics? A pilot observational study

      McCreesh, Samuel (2021-05-01)
      Pre-hospital treatment of suspected haemorrhagic pelvic fractures includes application of a purpose-made pelvic binder. Recent hospital studies identified poor accuracy of pelvic binder application, but there is little pre-hospital research to date. Abstract published with permission.
    • Trends, variations and prediction of staff sickness absence rates among NHS ambulance services in England: a time series study

      Asghar, Zahid; Wankhade, Paresh; Bell, Fiona; Sanderson, Kristy; Hird, Kelly; Phung, Viet-Hai; Siriwardena, Aloysius (2021-09-29)
      Our aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting. https://bmjopen.bmj.com/content/11/9/e053885 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-2021-053885