Now showing items 21-40 of 57

    • 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:, 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: DOI
    • 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; 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)
    • 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.
    • 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.
    • 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.
    • Resuscitation of patients with active Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) status after out-of-hospital cardiac arrest

      Barnard, Ed B.G.; Sandbach, Daniel D.; Nicholls, Tracy L.; Wilson, Alastair W.; Ercole, Ari (2019-09)
    • 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. 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:
    • 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; Amador, Sarah; Claire Goodman (2015-04)
    • Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

      Moore, Chris; Bulger, Jenna; Driscoll, Timothy; Porter, Alison; Islam, Saiful; smyth, mike; Perkins, Gavin D.; Sewell, Bernadette; Rainer, Timothy; Nanayakkara, Prabath; et al. (2018-03)
    • Mental health crisis in the pre-hospital setting

      Prothero, Larissa; Cooke, Philip (2016-09)
      Background The 2014 Mental Health Crisis Care Concordat is a national agreement to ensure people in crisis receive the help they need: integrated multi-agency schemes involving ambulance, police and mental health services are now being developed to provide urgent and emergency care pathways for these vulnerable patients. The aim of this study was to have improved understanding of mental health crisis (MHC) patients requiring ambulance care, to inform the development of new patient care pathways within the East of England. Methods A retrospective pilot audit was performed using 291 ‘MHC’ patient care records generated following emergency ‘999’ ambulance and non-emergency ‘111’ calls in a distinct geographical area of the East of England Ambulance Service NHS Trust between 22–29 December 2014. Criteria for record inclusion were presence of the terms ‘mental health’, ‘anxiety’, ‘depression’, ‘self-harm’, ‘self-injury’, ‘abnormal behaviour’, ‘psychosis’, ‘paranoia’, ‘suicide’, ‘suicidal thoughts’, ‘overdose’, ‘dementia’, or ‘Section’. Results The cohort age range was 13 to 98 years; 50.5% were male. MHC usually affected people under 65 years. The main reasons for ambulance care were deliberate drug/substance overdose (33.7%) and actions/behaviour associated with suicidal intention (19.2%) – attempted suicide was reported for 14 (4.8%) patients. Anxiety (including ‘panic attacks’/hyperventilation syndrome), depression and behavioural/emotional problems were prevalent. Alcohol consumption was reported for 36.8% patients and police attendance was required for aggressive/threatening behaviour in 22% of incidences. Approximately two-thirds (64.6%) of patients were conveyed to the emergency department; only 12 (4.1%) patients were directly admitted to a mental health facility. The majority of patient contacts occurred ‘out-of-hours’, in particular, between 20:00 and 22:00 hours. Conclusions Mental health crisis management is complex and challenging for ambulance clinicians with limited direct access to specialist services. Understanding the nature of crises and patient/public expectations of emergency services will facilitate the development of appropriate pre-hospital mental health pathways. 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: