Recent Submissions

  • 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
  • Experiences and views of people who frequently call emergency ambulance services: a qualitative study of UK service users

    Evans, Bridie; Khanom, Ashra; Edwards, Bethan; Foster, Theresa; Fothergill, Rachael; Gripper, Penny; Porter, Alison; Scott, Jason; Watkins, Alan; Edwards, Adrian; et al. (2023-08-09)
  • Case management of people who call 999 frequently – qualitative study of the perspective of people providing and receiving care (STRETCHED)

    Snooks, Helen; Khanom, Ashra; Cole, Robert; Edwards, Adrian; Evans, Bridie; Foster, Theresa; Gripper, Penny; Hampton, Chelsey; John, Ann; Petterson, Robin; et al.
  • A scoping review exploring the confidence of healthcare professionals in assessing all skin tones

    Harrison, Juliet (2023-09-01)
    Background: Health inequalities and poorer outcomes have been identified for patients with dark skin tones. The reasons are multi-factorial, but may include delayed treatment due to a lack of recognition of early clinical signs of physiological deterioration. Within the medical literature there is a light skin tone bias, leading to healthcare professionals having insufficient knowledge regarding the assessment of patients with different skin tones, which may result in reduced confidence and create patient safety issues. The aim of this scoping review was to explore the confidence levels of healthcare professionals when assessing patients of different skin tones. Methods: The methodology followed scoping review frameworks set out by Arksey and O’Malley (2005), the Joanna Briggs Institute (Peters et al., 2020) and the PRISMA extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018). Searches for literature were performed between February and June 2022 using electronic databases EBSCO (Academic Search Complete, the Allied Complementary Medicine Database, e-journals, MEDLINE, CINAHL), British Nursing Index (ProQuest), Scopus, Web of Science, Zetoc, UpToDate, Google Scholar, NICE Evidence, ResearchGate, Opengrey and the British Association of Dermatologists. No date range was specified, expanders were left on and the findings were screened using inclusion and exclusion criteria. Included papers were synthesised using narrative synthesis. Results: Thirteen papers were identified, and the extracted data charted by the paper’s origin, sample size, profession and confidence levels. Our synthesis revealed reduced confidence in assessing, managing and diagnosing skin conditions in dark skin tones. A lack of training was cited by different health professionals, but undertaking tailored training and experiential learning increased confidence. Conclusions: There is a safety issue for patients with dark skin tones, as healthcare professionals lack clinical confidence in managing and treating all ethnicities equally. Tangible diversity within healthcare training is required, supported by inclusive skin tone imagery and appropriate terminology within medical literature. Abstract published with permission.
  • Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: an observational registry cohort study

    Albargi, H; Mallett, S; Berhane, S; Booth, S; Hawkes, C; Perkins, G.D; Norton, M; Foster, T; Scholefield, B (Elsevier, 2022-01)
  • '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
  • Management of penetrating chest trauma in the context of major trauma networks

    Stretch, Benjamin; Kyle, Amy; Patel, Mihir (2022-10-02)
  • Clinical and cost-effectiveness of paramedic administered fascia iliaca compartment block for emergency hip fracture (RAPID 2)-protocol for an individually randomised parallel-group trial

    Kingston, Mark; Jones, Jenna; Black, Sarah; Evans, Bridie; Ford, Simon; Foster, Theresa; Goodacre, Steve; Jones, Marie-Louise; Jones, Sian; Keen, Leigh; et al.
  • Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: An observational registry cohort study

    Albargi, H; Mallett, S; Berhane, S; Booth, S; Hawkes, C; Perkins, Gavin; Norton, M; Foster, Theresa; Scholefield, B (2022-01)
  • Challenges of prehospital silver trauma patients

    Passarelli, Katie (2022-12-02)
    Silver trauma patients, defined as those aged >65 years who have traumatic injuries, are a complex group because physiology alters with age leading to difficulties with assessment. This is exacerbated within the prehospital setting as environmental factors and ambulance delays increase the risk of complications. This article focuses on the pathophysiology and application of clinical guidelines on three aspects of prehospital silver trauma: neurology, osteology and Silver trauma patients, defined as those aged >65 years who have traumatic injuries, are a complex group because physiology alters with age leading to difficulties with assessment. This is exacerbated within the prehospital setting as environmental factors and ambulance delays increase the risk of complications. This article focuses on the pathophysiology and application of clinical guidelines on three aspects of prehospital silver trauma: neurology, osteology and haemorrhage. Neurologically, silver trauma patients have a higher risk of traumatic brain injury and are harder to assess because of age-related cognitive decline. Regarding osteology, older people, particularly postmenopausal women, are at a higher risk of vertebral fracture, with many going undiagnosed. Haemorrhage is also influenced, as geriatric patients typically experience occult bleeding or rebleeding several days after an event when crews have left. Despite these risks, prehospital guidelines often offer little support for clinicians in making holistic, clinically sound decisions for their patients haemorrhage. Neurologically, silver trauma patients have a higher risk of traumatic brain injury and are harder to assess because of age-related cognitive decline. Regarding osteology, older people, particularly postmenopausal women, are at a higher risk of vertebral fracture, with many going undiagnosed. Haemorrhage is also nfluenced, as geriatric patients typically experience occult bleeding or rebleeding several days after an event when crews have left. Despite these risks, prehospital guidelines often offer little support for clinicians in making holistic, clinically sound decisions for their patients. Abstract published with permission.
  • STRategies to manage Emergency ambulance Telephone Callers with sustained High needs: an Evaluation using linked Data (STRETCHED) - a study protocol

    Aslam, Rabeea’h W.; Snooks, Helen; Porter, Alison; Khanom, Ashrafunnesa; Cole, Robert; Edwards, Adrian; Edwards, Bethan; Evans, Bridie A.; Foster, Theresa; Fothergill, Rachael; et al. (2022-03)
    UK ambulance services have identified a concern with high users of the 999 service and have set up ‘frequent callers’ services, ranging from within-service management to cross-sectoral multidisciplinary case management approaches. There is little evidence about how to address the needs of this patient group. https://bmjopen.bmj.com/content/12/3/e053123.info 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-2021-053123
  • Detection to Hospital Door: Gender Differences of Patients With Acute Stroke Symptoms

    Walter, Silke; Phillips, Daniel; Wells, Brittany; Moon, Robert; Bertsch, Thomas; Grunwald, Iris Q; Fassbender, Klaus (2022-04-07)
  • ‘Very hit and miss’: an interpretive phenomenological analysis of ambulance service care for young people experiencing mental health crisis

    Gee, Brioney; NIcholls, Helen; Rivett, Sam; Clarke, Tim; Wilson, Jon; Prothero, Larissa (2022-06-01)
    The ambulance service provides vital front line mental healthcare for young people in crisis, but there is a lack of evidence to guide best practice in this area. The lived experiences of service users can offer important insights to guide service development, therefore we carried out a qualitative evaluation of care provided by the ambulance service to young people experiencing a mental health-related emergency. Abstract published with permission.
  • 'Menopause affects us all . . .': menopause transition experiences of female ambulance staff from a UK ambulance service

    Prothero, Larissa; Foster, Theresa; Winterson, Debra (2021-12-01)
    There is limited research regarding the menopause transition in the emergency services; however, all women will experience this life phase, which can have a significant impact on personal well-being, workplace attendance and performance. The aim of this survey was to explore personal and work impacts of the menopause for all female staff in the ambulance setting. Abstract published with permission.
  • A survey-based evaluation of ambulance staff awareness of vitamin D and risk of deficiency in a UK ambulance service

    Prothero, Larissa; Foster, Theresa (2021-09)
    Healthcare professions, shift-working and indoor-working are risk factors for vitamin D deficiency. The aim of this survey was to investigate ambulance staff awareness of vitamin D, and the risks associated with deficiency, to inform the need for appropriate well-being resources. Abstract published with permission.
  • Randomised feasibility study of prehospital recognition and antibiotics for emergency patients with sepsis (PhRASe)

    Jones, Jenna; Allen, Susan; Davies, Jan; Driscoll, Timothy; Ellis, Gemma; Fegan, Greg; Foster, Theresa; Francis, Nick; Islam, Saiful; Morgan, Matt; et al. (2021-09-20)

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