• Aeromedical transfer to reduce delay in primary angioplasty

      Balerdi, Matthew; Ellis, Daniel Y.; Grieve, Philip; Murray, Paul; Dalby, Miles C. (2011-07)
    • Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices

      Bowles, Christopher T.; Hards, Rachel; Wrightson, Neil; Lincoln, Paul; Kore, Shishir; Marley, Laura; Dalzell, Jonathan R.; Raj, Binu; Baker, Tracey A.; Goodwin, Diane; et al. (2017-12)
      Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients. https://emj.bmj.com/content/emermed/34/12/842.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-2016-206172
    • Ambulance staff and end-of-life hospital admissions: A qualitative interview study

      Hoare, Sarah; Kelly, Michael P.; Prothero, Larissa; Barclay, Stephen (2018-10)
    • Assessing carbon monoxide poisoning

      Scott, Tricia; Foster, Theresa (2013-03)
    • 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.
    • 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.
    • Cardiac arrest and the role of transthoracic echocardiography

      Reed, Grace (2017-10)
      Abstract published with permission. The role of transthoracic echocardiography (TTE) is one of the top five research priorities in prehospital critical care (Fevang et al, 2011). TTE is a non-invasive diagnostic tool in cardiac arrest, using ultrasound images to visualise the realtime activity of the heart (Hernandez et al, 2008). TTE has the potential to reduce the time between the onset of cardiac arrest and appropriate therapy. There are several reversible causes of cardiac arrest that can be identified by TTE in the pre-hospital environment. The method and value of identifying pulmonary emboli (PE), cardiac tamponade and hypovolaemia will be discussed. Equally, TTE can exclude certain reversible causes, indicating that the cardiac arrest is of an irreversible nature and the resuscitation attempt is futile. The application of TTE in this context will be reviewed in depth, from the current literature to the physical practicalities. As such, the aim of the present study is to clarify the role of TTE in patients suffering out-of-hospital cardiac arrest.
    • Clinical handover

      Hicks, Emma (2013-12)
    • Developing and introducing a new triage sieve for UK civilian practice

      Stephenson, John; Andrews, Lewis; Moore, Fionna (2015-04)
    • Difference between how ambulance service personnel use paper and electronic patient care records when attending older people at home

      Buswell, Marina; Fleming, Jane; Lumbard, Phillip; Prothero, Larissa S.; Amador, Sarah; Claire Goodman (2015-04)
    • 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.
    • Exploring factors increasing paramedics’ likelihood of administering analgesia in pre-hospital pain: cross sectional study (explain)

      Asghar, Zahid; Siriwardena, Aloysius Niroshan; Phung, Viet-Hai; Lord, Bill; Foster, Theresa; Pocock, Helen; Williams, Julia; Snooks, Helen (2017-10)
      Background Paramedics play an important role in reducing pain in patients calling an ambulance. We aimed to identify how patient factors (age, sex), clinical condition and paramedic factors (sex, role seniority) affected pain treatment and outcomes. Methods We used a cross sectional design using routine retrospective data a one-week sample of all 999 ambulance attendances in two large regional UK ambulance services for all patients aged 18 years or over where pain was identified in people requiring primary transport to hospital. Exclusion criteria patients with a Glasgow Coma Scale score below 13, or patients not attended by a paramedic. We used a multilevel design, using a regression model to investigate which factors were independently associated with administration of analgesia and reduction in pain, taking into account confounders including patient demographics and other variables. Analysis was performed with Stata. Results We collected data on 9574 patients (service 1, 2; n=3344, 6230 respectively) including 4911 (51.3%) male and 4524 (47.3%) females (1.5% missing). Initial pain score was not recorded in 42.4% (4063/9574). The multilevel model suggested that the factors associated with use of strong opiates (morphine intravenously or orally) was a pain score of 7 or above, patient age 50–64 years and suspected fractured neck of femur. Reduction in pain score of 2 or more points was significant whatever the initial pain score and associated with age 50–84 years. There was no association between use of strong opiate analgesic or reduction in pain score and sex of patient and/or sex of paramedic or crew member. Conclusion Our initial analysis showed a high level of non-recording of pain scores. There was no association between use of strong opiate analgesics or reduction in pain score of 2 points or more with patient sex or crew sex or paramedic skill level. https://emj.bmj.com/content/34/10/e11 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-2017-207114.29
    • 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
    • How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project

      Voss, Sarah; Brandling, Janet; Taylor, Hazel; Black, Sarah; Buswell, Marina; Cheston, Richard; Cullum, Sarah; Foster, Theresa; Kirby, Kim; Prothero, Larissa; et al. (2018-08)
      https://bmjopen.bmj.com/content/8/7/e022549 Objectives An increasing number of older people are calling ambulances and presenting to accident and emergency departments. The presence of comorbidities and dementia can make managing these patients more challenging and hospital admission more likely, resulting in poorer outcomes for patients. However, we do not know how many of these patients are conveyed to hospital by ambulance. This study aims to determine: how often ambulances are called to older people; how often comorbidities including dementia are recorded; the reason for the call; provisional diagnosis; the amount of time ambulance clinicians spend on scene; the frequency with which these patients are transported to hospital. Methods We conducted a retrospective cross-sectional study of ambulance patient care records (PCRs) from calls to patients aged 65 years and over. Data were collected from two ambulance services in England during 24 or 48 hours periods in January 2017 and July 2017. The records were examined by two researchers using a standard template and the data were extracted from 3037 PCRs using a coding structure. Results Results were reported as percentages and means with 95% CIs. Dementia was recorded in 421 (13.9%) of PCRs. Patients with dementia were significantly less likely to be conveyed to hospital following an emergency call than those without dementia. The call cycle times were similar for patients regardless of whether or not they had dementia. Calls to people with dementia were more likely to be due to injury following a fall. In the overall sample, one or more comorbidities were reported on the PCR in over 80% of cases. Conclusion Rates of hospital conveyance for older people may be related to comorbidities, frailty and complex needs, rather than dementia. Further research is needed to understand the way in which ambulance clinicians make conveyance decisions at scene. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074617/pdf/bmjopen-2018-022549.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/bmjopen-2018-022549
    • 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.