Recent Submissions

  • Surveying young patients

    Foster, Theresa; Maillardet, Victoria (2010-03)
    The East of England Ambulance Service NHS Trust (the Trust) was keen to engage young patients and to encourage them to give feedback about the service they had received. The standard Trust satisfaction survey was modified for use with young patients, and this had the effect of increasing the response rate from this patient group by 8%, and increasing the percentage of young patients aged 5-10 years completing the survey themselves by 29%. The vast majority of parents/guardians were happy for the Trust to survey their child, but the age of the child affected to whom they would like the survey sent. The Trust subsequently altered patient survey practice to write to parents/guardians of patients aged <12 years and directly to all patients aged > or = 12 years. https://emj.bmj.com/content/27/3/221. 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.2008.065615
  • Research paramedics’ observations regarding the challenges and strategies employed in the implementation of a large-scale out-of-hospital randomised trial

    Green, Jonathan; Robinson, Maria; Pilbery, Richard; Whitley, Gregory; Hall, Helen; Clout, Madeleine; Reeves, Barnaby; Kirby, Kim; Benger, Jonathan (2020-06-01)
    Introduction: AIRWAYS-2 was a cluster randomised controlled trial (RCT) comparing the clinical and cost effectiveness of the i-gel supraglottic airway device with tracheal intubation in the initial airway management of out-of-hospital cardiac arrest (OHCA). In order to successfully conduct this clinical trial, it was necessary for research paramedics to overcome multiple challenges, many of which will be relevant to future emergency medical service (EMS) research. This article aims to describe a number of the challenges that were encountered during the out-of-hospital phase of the AIRWAYS-2 trial and how these were overcome. Methods: The research paramedics responsible for conducting the pre-hospital phase of the trial were asked to reflect on their experience of facilitating the AIRWAYS-2 trial. Responses were then collated by the lead author. A process of iterative revision and review was undertaken by the research paramedics to produce a consensus of opinion. Results: The main challenges identified by the trial research paramedics related to the recruitment and training of paramedics, screening of eligible patients and investigation of protocol deviations / reporting errors. Even though a feasibility study was conducted prior to the commencement of AIRWAYS-2, the scale of these challenges was underestimated. Conclusion: Large-scale pragmatic cluster randomised trials are being successfully undertaken in out-of-hospital care. However, they require intensive engagement with EMS clinicians and local research paramedics, particularly when the intervention is contentious. Feasibility studies are an important part of research but may fail to identify all potential challenges. Therefore, flexibility is required to manage unforeseen difficulties. Abstract published with permission.
  • Views regarding the provision of prehospital critical care in the UK

    Mackenzie, R.; Steel, A.; French, J.; Wharton, R.; Lewis, S.; Bates, A.; Daniels, T.; Rosenfeld, M. (2009-05-22)
    Aims: There is a lack of consensus regarding the role for critical care in the prehospital environment in the UK. It was hypothesised that this related to differences in views and understanding among opinion leaders within influential prehospital care organisations. Methods: A 38-item survey was developed by an established paramedic-physician prehospital critical care service. The survey was distributed to individuals in senior positions within seven organisations that have a major influence on UK prehospital services. Analysis comprised a description of the distribution of results, assessment of the level of agreement with each statement by professional background and current involvement in prehospital critical care and evaluation of the overall consistency of responses. Free-text comments were invited to illustrate the reasoning behind each response. Results: There were 32 respondents. The estimated response rate was 40%. The consistency of the questionnaire responses was very high. Overall, all individuals agreed with most of the statements. Paramedic respondents were more likely to disagree with statements that suggested that critical care involved interventions that exceed the current capability of the NHS ambulance service (p<0.05). Free-text comments revealed wide differences of opinion. Conclusion: Although there appears to be broad agreement among opinion leaders regarding the concepts underpinning existing prehospital critical care services, areas of contention are highlighted that may help explain the current lack of consensus. Cooperative efforts to assess the current demand and clinical evidence would assist in the creation of a joint consensus and allow effective future planning for the provision of prehospital critical care throughout the UK. https://emj.bmj.com/content/26/5/365. 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.2008.062588
  • Paramedic-led prehospital thrombolysis is safe and effective: the East Anglian experience

    Khan, S. N.; Murray, Paul; McCormick, L.; Sharples, L. S.; Salahshouri, P.; Scott, Jason; Schofield, P. M. (2009-05-22)
    Introduction: Prehospital thrombolysis has been shown to improve patient outcomes in clinical trials and this has been confirmed in the ongoing large national myocardial infarction registry (Myocardial Infarction National Audit Project; MINAP) reports. This paper describes a system to improve the delivery of prehospital thrombolysis and the associated governance requirements to gain maximum patient benefit. Methods: Demographic data were prospectively collected on all patients treated by the East Anglian Ambulance Trust with bolus thrombolytics for a presumed diagnosis of ST elevation myocardial infarction between November 2003 and February 2007. Survival status was determined from the NHS strategic tracing service. Results: 1062 patients (mean age 64.0 years (SD 10.6), 795 men) were treated in this time period. There were 71 deaths in this group, with actuarial survival of 93.9% (SE 0.9%) at 30 days, 91.7% (SE 1.0%) at 6 months and 90.8% (SE 1.1%) at 12 months after treatment. Age and cardiac arrest were most strongly associated with mortality (both p<0.001). Twelve (1.2%) patients received thrombolysis that on review was considered inappropriate. There were no deaths in this subgroup. Conclusions: Prehospital thrombolysis can be administered safely by ambulance staff supported by a Trust clinical support system with excellent clinical outcomes. https://emj.bmj.com/content/26/6/452. 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.2008.062729
  • What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

    Snooks, Helen; Khanom, Ashrafunnesa; Cole, Robert; Edwards, Adrian; Edwards, Bethan Mair; Evans, Bridie A.; Foster, Theresa; Fothergill, Rachael; Gripper, Carol P.; Hampton, Chelsey; et al. (2019-12-28)
  • Induced hypothermia in the management of head trauma: A literature review

    Ravenscroft, Tristan (2012-12)
    Abstract published with permission. Mild hypothermia treatment (MHT) involves a controlled decrease of core temperature in order to mitigate the secondary damage to organs that follows post primary injury. In the case of traumatic brain injury (TBI) suggestions that the brain could be conserved by cooling go back as far as the 1940s. The idea was to reduce cerebral metabolism and hypoxic insult by using MHT. However, more recent research suggests that this is a ‘simplistic view’ of brain cooling when there is in fact a much more complex web of effects that need to be understood and accounted. There clearly needs to be a variety of multi-disciplinary team based simultaneous pre-hospital and then in-hospital treatments to ameliorate harm (Nonmaleficence ) and enhance brain healing processes (Beneficence). Examination will take place of the varied probable mechanisms of action and contemporary evidence for and against the use of MHT in TBI. Discussion will range across issues such as target range of MHT, time to achieve this range, duration of cooling, and finally re-warming rates on neurological outcomes following TBI. This in turn, should create a clearer evidence base, for the UK paramedic practitioner who is considering using MHT in the pre-hospital setting in the minutes following TBI and inform decisions around: methods and timing of cooling; shivering prevention using sedation; reliable on-going monitoring of core temperature and team building with hospital services.
  • Raising a profession

    Martin, John (2012-12)
  • Baby on the way: Was an ambulance in the plan?

    Foster, Theresa; Maillardet, Victoria (2012-11)
    Abstract published with permission. Objectives The East of England Ambulance Service NHS Trust (the trust) sought the views of patients it attended who were imminently about to give birth at the time of the 999 call to the trust. This was a patient group who had previously never been specifically targeted by the trust as part of its on-going patient feedback activity to inform service development. Methods All imminent birth patients during a four consecutive month period from August to November 2008 were sent a questionnaire asking them about their contact and satisfaction with the ambulance service at the time of the birth. Results Results of this survey have shown that almost a fifth (19.4 %) of patients who had intended to give birth in hospital had planned to use the ambulance service for their transport. Perceived complications, severe pain, labour not progressing, or the advice of a midwife were the main reasons given for unplanned use of the service. In this sample, a greater percentage of patients who planned to give birth at a hospital or maternity centre actually gave birth at home (25.5 %), than was achieved by patients who had planned a home birth (16.7 %). Conclusions Further investigation is needed to inform developments in partnership working between ambulance and maternity services to better serve this patient group.
  • Hospital admission avoidance for people with exacerbations of chronic obstructive pulmonary disease (COPD) through collaborative working between Suffolk COPD services and East of England Ambulance service

    Pearce, L.J.; Broad, M.; Pulimood, T.B.; Laroche, C.M. (2011-12)
    Introduction BTS Guidelines recommend that admission avoidance schemes should be available for patients with exacerbations of COPD. The Suffolk COPD Service was established in 2009, operating 365 days/year. One strand of the service aims to avoid inappropriate hospital admission by encouraging GPs to refer to the service rather than sending patients into hospital. However, despite wide publicity hospital admission rates remained high. Review of 24 COPD hospital admissions suggested that 50% would have been suitable for admission avoidance through Suffolk COPD Services. 95% of these patients had been brought in to A&E by ambulance. Feasibility of direct ambulance referral into Suffolk COPD Services was discussed with ambulance personnel. Method A business case, working protocol and pathway were developed jointly, along with a robust clinical governance system. It was planned that a member of the Suffolk COPD Nursing team would visit the patient within 4 h of referral. Approval was gained from the Local Medical Council and Expert Clinical Steering Group. The system was launched following wide publicity and training of both ambulance and nursing staff. Results The first successful referral was received 40 min after the launch. In the first year 83 referrals were received, of which only eight were inappropriate and requiring redirection to other services or hospital admission. Advantages of ambulance referral system: < Reduction in ambulance call cycle time by up to 30 min < Increased ambulance personnel COPD knowledge < Development of patient group directives < Improved team working/collaboration across services < Ability to discharge duty of care to a specialist community service < Increased admission avoidance < People cared for in own home < “Self supported” care encouraged < Cost efficient Conclusion 73% were admissions avoided compared to the 50% which had been predicted. The collaboration was a successful model of service delivery, reducing hospital admissions by the seamless transition of the duty of care from the ambulance service to the Suffolk COPD Services, who supported the patient at home. https://thorax.bmj.com/content/thoraxjnl/66/Suppl_4/A105.2.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/thoraxjnl-2011-201054c.93
  • Aeromedical transfer to reduce delay in primary angioplasty

    Balerdi, Matthew; Ellis, Daniel Y.; Grieve, Philip; Murray, Paul; Dalby, Miles C. (2011-07)
  • Public and patient involvement in prehospital care research development – designing the rapid 2 trial

    Evans, Bridie A.; Bulger, Jenna; Ford, S.; Foster, Theresa; Goodacre, Steve; Jones, S.; Keen, L.; Longo, M.; Lyons, Ronan; Pallister, I.; et al. (2019-04-26)
    Background Involving patients and public members in research helps ensure evidence is relevant, accountable and high quality. Public and patient involvement (PPI) is required in many funding applications. We aimed to involve public contributors in designing a research bid about prehospital management for hip fracture. Method We recruited two public contributors with experience of hip fracture and prehospital care to our research team of academic, clinical and managerial partners developing the RAPID 2 proposal evaluating paramedic administration of Fascia Iliaca Compartment Block, a local anesthetic injection into the hip. We supported them to consult with a public/patient group and identify patient priorities to inform our decisions. We held research development meetings and shared project drafts to gain views, share decisions and amend documents. Results Consultation responses suggested patient priorities after hip fracture were to return home, recover mobility and gain independence. These views guided our decisions on setting primary outcomes which were length-of-hospital-stay and health-related quality-of-life. Their concern about the study design causing delayed access to treatment meant we decided to identify common exclusion criteria before randomisation to expedite access to pain management and reduce attrition. Public contributors also agreed patients should be offered an incentive for completing and returning questionnaires to enhance data completeness. Conclusion Involving public contributors enabled the research team to identify patient-prioritised outcomes and adjust the proposed study design to reflect these in the proposal. Public contributors will remain involved if funding is awarded to ensure patient perspectives inform all stages of research management and dissemination. Conflict of interest None. Funding PRIME Centre Wales. 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/., https://bmjopen.bmj.com/content/9/Suppl_2/A8.2 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/bmjopen-2019-EMS.22
  • What is the paramedic's role in smoking cessation?

    Wilson, Sophia; Hill, Lawrence (2019-03-13)
    Background: Both the National Institute for Health and Care Excellence (NICE) and Public Health England have made smoking cessation a health promotion priority but the paramedic's potential impact in this important area has yet to be fully realised. Aim: This article proposes an evidence-based quality improvement intervention that can be adopted by paramedics at an individual, service-wide or national level to promote smoking cessation. Methodology: Building on a structured literature review and using the three fundamental questions and a Plan Do Study Act cycle, we propose a quality improvement strategy and evaluation methodology suited to the aims of the article. Discussion: Very Brief Advice is an evidence-based, effective and time-efficient way of reducing harm from smoking and improving quality of life for patients, saving NHS money as well as increasing paramedic job satisfaction. Abstract published with permission.
  • Scoping ambulance emissions: recommendations for reducing engine idling time

    Sheldon, Amber; Hill, Lawrence (2019-07-10)
    The NHS is a significant contributor to the UK's greenhouse gases and environmental pollution. The current review seeks to examine the degree to which ambulance services contribute to environmental pollution and provides quality improvement suggestions that may reduce emissions, save money and improve public health. A literature search was conducted to identify the English language literature for the past 7 years related to ambulance service carbon emissions and pertinent strategies for reducing harm. An average of 31.3 kg of carbon dioxide (CO2) is produced per ambulance response in the current box-shaped ambulance design. A number of quality improvement suggestions related to cost, emissions and public health emerge. Ambulance services should consider a range of system-level and individual-focused interventions in order to reduce emissions, save money and promote public health. Abstract published with permission.
  • The use of Penthrox (methoxyflurane) in trauma patients

    Sevillano-Barbero, Manuel; Ruddy, Claire (2019-09-17)
  • Does digoxin cause more harm than good?

    Reed, Grace (2019-04-08)
    Background: The most recent British National Formulary recommends digoxin therapy for patients with heart failure (HF) and/or supraventricular arrhythmias, particularly atrial fibrillation (AF) and atrial flutter. The positive inotropic and negative chronotropic effects of the drug are undoubtedly desirable when managing these conditions, yet the use of digoxin is decreasing in popularity among prescribers. Aim: The aim of this literature review is to evaluate the use of digoxin for treating HF and/or AF. It will highlight the benefits of digoxin as well as its potential risks. These should be considered by all prehospital staff when assessing patients who are prescribed digoxin. Conclusions: Digoxin has shown positive outcomes for reducing hospital admissions for patients with HF and/or AF. However, clinicians should be aware of the narrow therapeutic index, which results in a high incidence of digoxin toxicity. The adverse effects of digoxin use should be considered during prehospital assessment, inclusive of pro-arrhythmic and thromboembolic complications. Whether digoxin may result in harm depends on the age, underlying pathology and renal function of each individual patient. Abstract published with permission.
  • Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics

    Snooks, Helen A.; Carter, Ben; Dale, Jeremy; Foster, Theresa; Humphreys, Ioan; Logan, Philippa A.; Lyons, Ronan A.; Mason, Suzanne M.; Phillips, Ceri J.; Sanchez, Antonio; et al. (2014-09)
  • Clinical handover

    Hicks, Emma (2013-12)
  • Assessing carbon monoxide poisoning

    Scott, Tricia; Foster, Theresa (2013-03)
  • Response to ‘Paramedic treatment—wherever that may be?’

    Boor, Sally (2014-02)
    Abstract published with permission. Sally Boor, paramedic, East of England Ambulance Service NHS Trust responds to James Price's article on the Hazardous Area Response Team (HART), published in last month's issue of the Journal of Paramedic Practice.

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