• Too much of a good thing? Oxygen alert cards are helpful for chronic obstructive pulmonary disease patients at risk of oxygen toxicity

      Tooley, S.; Ellis, D.; Greggs, D.; Scott, J. (2006-11-17)
      It is well established that optimal oxygen therapy needs to be provided for patients with COPD while they are being transferred to hospital, or assessed in A&E. (Murphy et al 2001, Durrington et al 2005). The objective is to give appropriate oxygen to support their needs while avoiding the risk of CO2 retention and respiratory acidosis. https://thorax.bmj.com/content/61/suppl_2/ii57 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/
    • 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
    • Simulation as a tool to improve the safety of pre‐hospital anaesthesia – a pilot study

      Batchelder, Andrew; Steel, Alistair; Mackenzie, Roderick; Hormis, Anil; Daniels, T.; Holding, N. (2009-08-03)
    • 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
    • Aeromedical transfer to reduce delay in primary angioplasty

      Balerdi, Matthew; Ellis, Daniel Y.; Grieve, Philip; Murray, Paul; Dalby, Miles C. (2011-07)
    • 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
    • Paramedic clinical leadership

      Martin, John; Swinburn, Andy (2012-03)
      Developing the paramedic profession is at the heart of the mission for the College of Paramedics. As any profession develops it evolves to take leadership and responsibility for a growing body of knowledge that informs practice. Back in 2008 the College published the second edition of the curriculum framework for paramedics clearly outlining the need for the development of roles at a variety of clinical levels. Having these levels populated creates a clinical framework that will deliver patient benefit and develop future paramedic practice. At its recent Council meeting the College outlined the need to develop education standards, clinical guidelines, and voluntary regulation for these emerging elements on the career framework, and is set to do this over the coming year. In this article Andy Swinburn the College Council representative for NW region outlines how the North West Ambulance Service NHS Trust has put into place a structured career development spanning the professional roles from first registration to consultant practice. https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2012.4.3.181 ] 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/10.12968/jpar.2012.4.3.181
    • 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.
    • 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)
    • Assessing carbon monoxide poisoning

      Scott, Tricia; Foster, Theresa (2013-03)
    • Clinical handover

      Hicks, Emma (2013-12)
    • 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.
    • Using clinical decision making and reflection strategies to support practice

      Hibberd, Jane M.; Chia, Swee Hong; Spindler, Alice; Walsh, Michaella; Wigginton, Sophie (2014-05)
      Abstract published with permission. Clinical decision making and reflection are essential skills for any health care professional to possess in that they underpin and enhance practice by providing a robust framework for structuring one’s thinking and subsequent actions. This article highlights the need for the study of clinical decision making which forms a vital part of the paramedic’s practice. It provides a background to clinical decision making before presenting an example case study.
    • A brief history of analgesia in paramedic practice

      Lord, Bill; Nicholls, Tracy L. (2014-08)
      Abstract published with permission. Paramedics and ambulance clinicians have an important role in alleviating pain. However, clinician-initiated analgesia has a relatively short history when compared with the field of medicine. Several barriers to the introduction of pharmacological options for the management of pain appear to have delayed the introduction of options for managing severe pain. These include legislative restrictions as well as concerns about the adverse effects of analgesics. This report describes the history of analgesia in paramedic or ambulance practice in the United Kingdom (UK) and Australia in order to add to the knowledge base for this profession, and to inform the development of strategies to advance pain management practice.
    • Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics

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