Recent Submissions

  • Prehospital transdermal glyceryl trinitrate for ultra-acute ischaemic stroke: data from the RIGHT-2 randomised sham-controlled ambulance trial

    Appleton, Jason; Woodhouse, Lisa; Anderson, Craig; Ankolekar, Sandeep; Cala, Lesley; Dixon, Mark; England, Timothy; Krishnan, Kailash; Mair, Grant; Muir, Keith; et al. (2023-06-08)
  • “It's like a swan, all nice and serene on top, and paddling like hell underneath": community first responders' practices in attending patients and contributions to rapid emergency response in rural England, United Kingdom-a qualitative interview study

    Patel, Gupteswar; Phung, Viet-Hai; Trueman, Ian; Pattinson, Julie; Botan, Vanessa; Hosseini, Seyed Mehrshad Parvin; Orner, Roderick; Asghar, Zahid; Smith, Murray D.; Rowan, Elise; et al. (BMC, 2023-02)
  • Medical priority dispatch system breathing problems protocol key question combinations are associated with patient acuity

    Clawson, Jeff; Barron, Tracey; Scott, Greg; Siriwardena, Aloysius; Patterson, Brett; Olola, Christopher
  • Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2)

    Dixon, Mark; Appleton, Jason P; Scutt, Polly; Woodhouse, Lisa J.; Haywood, Lee J; Havard, Diane; Williams, Julia; Siriwardena, Aloysius; Bath, Philip; RIGHT-2 Investigators (BMJ, 2022-11-21)
    OBJECTIVES: Ambulances offer the first opportunity to evaluate hyperacute stroke treatments. In this study, we investigated the conduct of a hyperacute stroke study in the ambulance-based setting with a particular focus on timings and logistics of trial delivery. DESIGN: Multicentre prospective, single-blind, parallel group randomised controlled trial. SETTING: Eight National Health Service ambulance services in England and Wales; 54 acute stroke centres. PARTICIPANTS: Paramedics enrolled 1149 patients assessed as likely to have a stroke, with Face, Arm, Speech and Time score (2 or 3), within 4hours of symptom onset and systolic blood pressure >120mm Hg. INTERVENTIONS: Paramedics administered randomly assigned active transdermal glyceryl trinitrate or sham. PRIMARY AND SECONDARY OUTCOMES: Modified Rankin scale at day 90. This paper focuses on response time intervals, distances travelled and baseline characteristics of patients, compared between ambulance services. 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:
  • A pre-hospital mixed methods systematic review protocol

    McManamny, Tegwyn; Ortega, Marishona; Munro, Scott; Jennings, Paul; Whitley, Gregory A. (2023-09-01)
    Introduction: Mixed methods research, a methodology entailing the integration of qualitative and quantitative data within a single study, offers researchers the ability to investigate complex processes and systems in health and healthcare. The collective strength gained through the data combination can provide an enhanced understanding of research problems, providing an ideal solution to understanding complex clinical issues in a range of settings. In pre-hospital practice, where often uncontrollable variables and environmental considerations increase healthcare complexity, mixed methods has emerged as a valuable approach to research. Aims: Given the exponential growth of pre-hospital mixed methods research since the publication of our first systematic review in 2014, we aim to provide an update. Our review will explore how mixed methods is utilised in pre-hospital research and identify what standards of reporting are achieved. Methods: This systematic review update will search MEDLINE, CINAHL Complete, Embase and Scopus bibliographic databases from 1 January 2012 to 15 March 2023, using an updated pre-hospital search strategy. Study screening will be performed in duplicate. Articles reported in English, explicitly stating the use of ‘mixed methods’ in the pre-hospital ambulance setting, including helicopter emergency medical services and community first-responder services, will be included. Data related to underpinning philosophy or theoretical framework, rationale for utilising mixed methods, background of the corresponding author, mode of data integration, model of publication and adherence to reporting standards, utilising the good reporting of a mixed methods study (GRAMMS) guidelines, will be extracted and analysed. All extracted data from study articles will be summarised in a table, allowing analysis of included studies against specified criteria. Abstract published with permission.
  • Predictors of conveyance to hospital by ambulance services of care home patients

    Botan, Vanessa; Law, Graham; Laparidou, Despina; Phung, Viet-Hai; Curtis, Ffion; Whitley, Gregory; Akanuwe, Joseph; Rowan, Elise; Fothergill, Rachael; McCranor, Tracy; et al. (2023)
  • Student paramedic exposure to workplace violence: a scoping review

    Belk, Stephanie; Armstrong, James; Ilczak, Tomasz; Webster, Carl A.; Sumera, Kacper (2024)
  • Senior Aircraftman Peter Kenyon

    Kenyon, Peter (MAG Online, 2015-04-02)
    A support worker in the RAF Reserves shares his experiences. Abstract published with permission.
  • An early warning precision public health approach for assessing COVID-19 vulnerability in the UK: the Moore-Hill Vulnerability Index (MHVI)

    Moore, Harriet Elizabeth; Hill, Bartholomew; Emery, Jay; Gussy, Mark; Siriwardena, Aloysius; Spaight, Robert; Tanser, Frank (2023)
  • Novel moving, handling and extraction simulation for students in a soft play area

    McKenzie, John W. B.; Horne, Emma; Smith, Benjamin; Tapson, Ella R.; Whitley, Gregory (2023)
    Background: Emergency medical services often have to extricate patients from their location and take them to an ambulance. High-quality training is required to ensure patient and staff safety during moving, handling and extrication manoeuvres. This study aimed to determine student satisfaction and self-confidence regarding what they had learnt after a novel moving, handling and extrication simulation exercise in a children's soft play area. Methods: A mixed-methods cross-sectional survey was adopted, using the validated Student Satisfaction and Self-Confidence in Learning survey tool. Qualitative data were collected from an open question for additional comments. Student paramedics and student emergency medical technicians from one higher education institution completed four time-limited scenarios, each of which involved moving an immobile patient away from their environment. Descriptive statistics were determined for the participant characteristics and survey responses. Thematic analysis was performed on the qualitative data. Results: The student participants were aged 18–47 years and the majority were women. They were satisfied with both their learning and their self-confidence in what they had learnt after the simulation event, and felt their communication and teamwork skills had improved. They enjoyed the event more than classroom-based simulation. While they felt the simulation was realistic, suggestions were made to make it more so. Conclusion: Use of a children's soft play area for a moving, handling and extrication simulation provided student satisfaction and self-confidence in learning. Abstract published with permission.
  • Factors that influence child conveyance decisions made by prehospital clinicians

    Blake-Barnard, Alex; Whitley, Gregory (2024-02-02)
    Abstract Introduction: The decision to convey children to emergency departments is complex. This study aimed to identify barriers and enablers to making appropriate decisions, along with areas of disparity in this decision-making process by ambulance clinicians. Methods: A rapid evidence review was conducted. MEDLINE, CINAHL and PubMed were searched from 2012 to July 2023. Critical appraisal and thematic synthesis were performed. Results: Three studies were identified, which highlights the lack of research in this area. Five themes were identified: provision of care; equipment and protocols; exposure, experience and confidence; emotional and social circumstances; and education or skill set. Findings: Enhanced paediatric education is required before and after registration to ensure appropriate conveyance and address clinicians' lack of exposure, experience and confidence. Protocols and guidelines should be drawn up to support decision-making for lower-acuity child patients. Specialist paediatric roles are required in ambulance services to support clinicians and provide advanced patient-centred care. Conclusions: The findings of this review provide a basis for discussion and clinical practice improvement. Research to determine the clinical and cost effectiveness of implementing prehospital specialist paediatric roles is required. Abstract published with permission
  • Trends in use of intraosseous and intravenous access in out-of-hospital cardiac arrest across English ambulance services: a registry-based, cohort study

    Vadeyar, Sharvari; Buckle, Alexandra; Hooper, Amy; Booth, Scott; Deakin, Charles; Fothergill, Rachael; Chen, Ji; Nolan, Jerry P; Brown, Martina; Cowley, Alan; et al. (2023-10)
  • A Systematic review of ambulance service based randomised controlled trials in stroke

    Dixon, Mark; Appleton, Jason P.; Siriwardena, A. Niroshan; Williams, Julia; Bath, Philip M. (2023-07-05)
  • Characteristics and costs of individuals experiencing severe hypoglycaemia requiring emergency ambulance assistance in the community

    Khunti, Kamlesh; Fisher, Harriet; Paul, S; Mohammad, Iqbal; Davies, Melanie J.; Siriwardena, Aloysius N. (Springer, 2012-10)
  • Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta-synthesis

    Whitley, Gregory; Wijegoonewardene, Nimali; Nelson, David; Curtis, Ffion; Ortega, Marishona; Siriwardena, Aloysius
  • Determining current approaches to the evaluation of the quality of healthcare simulation-based education provision: a scoping review

    Pogson, Rachel; Henderson, Helen; Holland, Matt; Sumera, Agnieszka; Sumera, Kacper; Webster, Carl (2023-10-05)
  • The Impact of specialist practitioners within an English ambulance service

    Spaight, Robert; Clarke, R; England, L; Fryer, C
    Background Specialist Practitioners were introduced to East Midlands Ambulance Service in September 2020. Three Cohorts of SP's have been introduced who have undertaken additional training and education in order to assess minor illness and injuries which may reduce the need for a visit to accident and emergency department. Method Analysis of the clinical analytics data suite matched to the Call data sets and compared with wider cohorts of paramedics to understand the impact of each of the three cohorts since their introduction to the Trust. Results Specialist Practitioner(SP) n=37 have attended (n=16,557) conveyed 36.73% (n=6082) EMAS 44.41% SP variance -7.68%, cohort 1 (CH1) commencement date 28/ 09/20 n=12 (n=7731) conveyed 33.07% CH1 variance - 11.34%, Category 1 calls 48.93% (EMAS 56.88% Variance -7.95%) Category 2 calls 38.66% (EMAS 57.95 Variance - 19.29) Category 3 calls 22.41% (EMAS 32.31% Variance - 9.90) Cohort 2(CH2) commencement date 19/10/20 n=12 have attended (n=6103) conveyed 42.08% (n=2568) SP variance -2.33, Category 1 calls 57.22% (Variance +0.32) Category 2 calls 50.16% (EMAS 57.95 variance -7.79) Category 3 calls 30.12% (EMAS 32.31 variance -2.19). Cohort 3(CH3) commencement date 20/07/21 n=13 have attended (n=2716) conveyed 35.20% (EMAS 44.41 variance -9.21) Category 1 calls 52.97% (Variance -3.91) Category 2 calls 39.51% (Variance -18.44) Category 3 calls 22.99% (variance -9.32). SP Cohort all category variance (33.07 - 42.08). Conclusion The initial three cohorts have all provided significant impact on the conveyance rate of the patient's seen. As this role becomes more embedded the true benefits will be seen through reduced conveyance and support for other crews on the front line. 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: DOI

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