• Temporal changes in bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Hawkes, Claire A.; Booth, Scott J.; Fothergill, Rachael; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2017-09)
    • Traumatic brain injuries: continuing dilemmas in the pre-hospital care arena

      Griffin, Dylan (2013-02)
      Abstract published with permission. This article examines the clinical assessment, diagnosis and management of an agitated traumatic brain-injured patient in the pre-hospital setting by a UK Helicopter Emergency Medical (HEMS) Team. Using a case study from clinical practice, the signs and symptoms, aetiology and clinical management options are discussed and compared against current best evidence, with the specific aims of improving mortality and morbity in critically-ill traumatic brain-injured patients.
    • Understanding a new model of leadership

      Johnson, David; Bainbridge, Peter; Hazard, Wendy (2013-12)
      Abstract published with permission. Leadership is an essential feature of the life of a paramedic. During incidents, whilst working with multi-agency colleagues, and within organisations, leadership is an expected quality of paramedics. Across health and social care organisations leadership is said to be of pivotal importance to future success. This has led to a large investment in leadership development programmes that organisations are now seeking to justify. Leadership as a concept is, however, complex and multifaceted. The nature of leadership has been debated over millennia and still disagreement exists as to how to define it. This paper utilises Critical Interpretive Synthesis to consider how approaches to leadership have developed over time. It concludes with a synthesising argument that leadership is a social construct; as such no single definition will ever be appropriate; however, the four elements that comprise the leadership equation should be considered if the paramedic leader is to be effective.
    • Understanding how Eastern European migrants use and experience UK health services: a systematic scoping review

      Phung, Viet-Hai; Asghar, Zahid; Matiti, Milika; Siriwardena, Aloysius (2020-03-06)
    • Unexpected shock in a fallen older adult: a case report

      Matthews, Gary; Booth, Helen; Whitley, Gregory (2020-06-01)
      Abstract published with permission. Introduction: Falls are common in older adults and frequently require ambulance service assistance. They are the most frequent cause of injury and associated morbidity and mortality in older adults. In recent years, the typical major trauma patient has changed from being young and male to being older in age, with falls of < 2 metres being the most common mechanism of injury. We present a case of an 84-year-old male who had fallen in his home. This case highlights the complex nature of a relatively common incident. Case presentation: The patient was laid on the floor in the prone position unable to move for 12 hours. He did not complain of any pain in his neck, back, hips or legs, and wished to be lifted off the floor promptly. On examination, he had bruising to his chest and abdomen and had suffered a suspected cervical spine injury due to a step-like protrusion around C5–C6. Distal sensory and motor function was intact. While in the ambulance his blood pressure dropped from 154/119 mmHg to 49/28 mmHg unexpectedly. We successfully reversed the shock using the modified Trendelenburg position and intravenous fluids. On follow-up he was diagnosed with dislocated C3, C6 and C7 vertebrae. Conclusion: The unexpected episode of shock witnessed in this patient may have been caused by a number of phenomena, including but not limited to crush syndrome, spinal cord concussion and orthostatic hypotension. We recommend that clinicians anticipate sudden shock in older adult patients who have fallen and a) have remained static on the floor for an extended period of time or b) are suspected of a spinal injury. We recommend assertive management of these patients to mitigate the impact of shock through postural positioning and consideration of early cannulation.
    • What are the predictors, barriers and facilitators to effective management of acute pain in children by ambulance services? A mixed-methods systematic review protocol

      Whitley, Gregory; Siriwardena, Aloysius; Hemingway, Pippa; Law, Graham Richard (2018-09)
      Abstract published with permission. Introduction: The management of pain is complex, especially in children, as age, developmental level, cognitive and communication skills and associated beliefs must be considered. Without effective pain treatment, children may suffer long-term changes in stress hormone responses and pain perception and are at risk of developing posttraumatic stress disorder. Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. The aim of this review is to identify predictors, barriers and facilitators to effective management of acute pain in children by ambulance services. Methods: A mixed-methods approach has been adopted due to the research question lending itself to qualitative and quantitative inquiry. The segregated methodology will be used where quantitative and qualitative papers are synthesised separately, followed by mixed-methods synthesis (meta-integration). We will search from inception: MEDLINE, CINAHL and PsycINFO via EBSCOHost, EMBASE via Ovid SP, Web of Science and Scopus. The Cochrane Library, the Joanna Briggs Institute, PROSPERO, ISRCTN and ClinicalTrials.gov will be searched. We will include empirical qualitative and quantitative studies. We will exclude animal studies, reviews, audits, service evaluations, simulated studies, letters, Best Evidence Topics, case studies, self-efficacy studies, comments and abstracts. Two authors will perform full screening and selection, data extraction and quality assessment. GRADE and CERQual will determine the confidence in cumulative evidence. Discussion: If confidence in the cumulative evidence is deemed Moderate, Low or Very Low, then this review will inform the development of a novel mixed-methods sequential explanatory study which aims to comprehensively identify predictors, barriers and facilitators to effective pain management of acute pain in children within ambulance services. Future research will be discussed among authors if confidence is deemed High.
    • What do users value about the emergency ambulance service?

      Togher, Fiona Jayne; Turner, Janette; Siriwardena, Aloysius; O'Cathain, Alicia (2015-05)
      Introduction Response times have been used as a key quality indicator for emergency ambulance services in the United Kingdom, but criticised for their narrow focus. Consequently, there is a need to consider wider measures of quality. The patient perspective is becoming an increasingly important dimension in pre-hospital outcomes research. To that end, we aimed to investigate patients' experiences of the 999 ambulance service to understand the processes and outcomes important to them. Methods We employed a qualitative design, using semi-structured interviews with a purposive sample of people who had recently used a 999 ambulance in the East Midlands. We recruited patients of different age, sex, geographical location, and ambulance service response including ‘hear and treat’, ‘see and treat’ and ‘see and convey’. Results We interviewed 20 service users. Eleven men and nine women participated and 12 were aged 65 years and over. Users valued a quick response when they perceived the call to be an emergency. This was of less value to those who did not perceive their situation as an emergency and irrelevant to ‘hear and treat’ users. All users valued the professional approach and information and advice given by call handlers, crew and first responders, which provided them with reassurance in a worrying situation. ‘See and convey’ users valued a seamless handover to secondary care. Limitations We found it challenging to engage participants to consider quality indicators beyond response times because these were considered to be abstract in comparison with their concrete experiences. Conclusions and recommendations Aspects other than response times were important to patients, particularly in situations perceived by patients to be non-emergency. The results will be combined with issues identified from systematic reviews and used in a Delphi study to identify candidates for new outcome measures for emergency ambulance services. https://emj.bmj.com/content/emermed/32/5/e9.2.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-2015-204880.24