• 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/
    • UK ambulance services: collaborating to provide good end-of-life care

      Stead, Sarah; Datta, Shirmilla; Hill, James; Smith, Richard; Nicell, Claire (2018-05)
    • Unplanned, urgent and emergency care: what are the roles EMS provide for older people with dementia? A literature review and narrative synthesis

      Buswell, Marina; Martin, Steven; Lee, Caroline; Lumbard, Phillip; Prothero, Larissa (2015-05)
      Background Anecdotally emergency ambulance crews say they frequently encounter older people with dementia (OPWD) and it can be difficult to take history, assess pain and access suitable alternatives to the emergency department especially out of hours. With the current policy landscape of the NHS England Emergency & Urgent Care Review and the high profile of dementia care it is pertinent to ask what role emergency medical services (EMS) have in the urgent and emergency care of OPWD. Methods Aware that the research literature in this area was likely to be sparse we used systematic and iterative search techniques to identify relevant studies and documents. All databases available via NHS Evidence were searched and grey literature was included. Articles which made any reference to the pre-hospital role of EMS ambulance services/personnel in the urgent or emergency care of OPWD were included. Discharge roles were excluded. Results Nineteen relevant documents were included for review and synthesis, over half from the grey literature. Eight were specifically about EMS treating OPWD, six of those from the grey literature. The other documents, though mentioning the role, were not researching or evaluating that role. We identified three roles described in the literature; emergency transport, assess and manage, and a last resort/safety net role. This final role is alluded to in over one third of the documents but is not investigated. Conclusions and recommendations This review highlights a gap in our understanding and in the research literature about the role EMS play in the care of OPWD, particularly around the last resort/safety net role. We hope it will encourage researchers from EMS and dementia care disciplines to come together, particularly to look at: ▸ Better understanding the last resort/safety net role. ▸ Evaluating AND reporting in the research literature initiatives that are happening in EMS around caring for OPWD. https://emj.bmj.com/content/emermed/32/5/e4.1.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-2015-204880.10
    • Unplanned, urgent and emergency care: what are the roles that EMS plays in providing for older people with dementia? An integrative review of policy, professional recommendations and evidence

      Buswell, Marina; Lumbard, Philip; Prothero, Larissa; Lee, Caroline; Martin, Steven; Fleming, Jane; Goodman, Claire (2016-01)
      Objective To synthesise the existing literature on the roles that emergency medical services (EMS) play in unplanned, urgent and emergency care for older people with dementia (OPWD), to define these roles, understand the strength of current research and to identify where the focus of future research should lie. Design An integrative review of the synthesised reports, briefings, professional recommendations and evidence. English-language articles were included if they made any reference to the role of EMS in the urgent or emergency care of OPWD. Preparatory scoping and qualitative work with frontline ambulance and primary care staff and carers of OPWD informed our review question and subsequent synthesis. Results Seventeen literature sources were included. Over half were from the grey literature. There was no research that directly addressed the review question. There was evidence in reports, briefings and professional recommendations of EMS addressing some of the issues they face in caring for OPWD. Three roles of EMS could be drawn out of the literature: emergency transport, assess and manage and a ‘last resort’ or safety net role. Conclusions The use of EMS by OPWD is not well understood, although the literature reviewed demonstrated a concern for this group and awareness that services are not optimum. Research in dementia care should consider the role that EMS plays, particularly if considering crises, urgent care responses and transitions between care settings. EMS research into new ways of working, training or extended paramedical roles should consider specific needs and challenges of responding to people with dementia. https://emj.bmj.com/content/emermed/33/1/61.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-2014-203941
    • The use of Penthrox (methoxyflurane) in trauma patients

      Sevillano-Barbero, Manuel; Ruddy, Claire (2019-09-17)
    • 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.
    • 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
    • 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)
    • What happened on Restart a Heart Day 2017 in England?

      Brown, Terry P.; Perkins, Gavin D.; Lockey, Andrew S.; Soar, Jasmeet; Askew, Sara; Mersom, Frank; Fothergill, Rachael; Cox, Emma; Black, Sarah; Lumley-Holmes, Jenny (2018-09)
    • 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.