RSS 1.0Publications - London Ambulance Service
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Not a dull momentHaving now become an NQP2, Katy Sofield reflects on her journey since joining the London Ambulance Service and shares her most memorable recent patient experiences. Abstract published with permission.
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Experiences of homeless individuals using ambulance services: a narrative reviewBackground: Homeless individuals are vulnerable and have a higher burden of illness. Barriers to care exist and experiences can be negative, contributing to increased morbidity and mortality. The experiences of homeless individuals accessing healthcare through ambulance services is underexplored. Aims: The study aims to describe why homeless individuals access healthcare through ambulance services and identify lived experiences. Methods: A narrative literature review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology, with Critical Appraisal Skills Programme tools used to assess quality before thematic synthesis. Results: Twenty three studies were included. Six themes were identified including frequency of ambulance use and clinical characteristics, why healthcare is accessed through ambulance services and the experiences of homeless individuals and paramedics. Conclusions: Evidence relating to homeless individuals accessing healthcare through ambulance services is limited. However, it is clear this group uses these services more often than non homeless individuals, likely because of their higher chronic illness burden. Services should be developed to meet the needs of homeless individuals and to help ensure demand on ambulance services is manageable and affordable. Abstract published with permission.
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Paramedics at risk? How responding to a terror attack affects mental wellbeingBackground: Terror attacks have a significant impact on first responders’ wellbeing, with an associated risk of post-traumatic stress disorder (PTSD). Aims: To improve understanding of how responding to terror attacks affects paramedics’ mental health. Methodology: A literature search was carried out on databases using the PRISMA strategy. Critical appraisal tools were used alongside thematic analysis to appraise and synthesise the literature. Findings: Ten papers were identified. Themes arising regarding risks to responders included: the level of exposure, with the amount related to the risks of developing PTSD and psychopathology; and level of preparedness, with responders carrying out unfamiliar tasks and working outside the scope of practice as well as lacking education on the psychological impact of terror attacks. Conclusion: If paramedics are deployed into terror attack warm zones, policy needs to consider the associated psychological risk. Training should incorporate stress management techniques and education on the extreme emotions these practitioners may experience. More research specifically with the paramedic population is required to understand the risk posed to them and how this may be managed. Abstract published with permission.
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To err is an opportunityOverall, this summer has been a good one. I re-started scuba diving. Now that I have a steady income, I can take up an old hobby. I have rekindled my love for the water and being under water – though, at 17˚C, the UK waters are a tad colder than the lovely 28˚C waters of the Dominican Republic I visited in March. July also saw graduation. Despite finishing university in September 2023, graduation was held in July 2024. It was lovely to spend a week back in the North of England, seeing old mentors and friends. During graduation, I had the opportunity to speak with my tutors that had moved on to different pastures. It was lovely to see them and tell them about my adventures in London.However, the week before graduation, while on a day shift, I made my first major error. I attended to a patient who was fitting. In the London Ambulance Service (LAS), we administer Midazolam to assist in terminating seizure activity. Abstract published with permission.
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Death notification delivery and training methodsFor a paramedic, delivering a death notification (DN) is one of the most difficult and stressful messages they will have to communicate in practice. Stress and anxiety in both recipients and paramedics have been documented through a limited literature base. The current review seeks to understand the existing educational tools and training around DN, and evaluates the applicability of these in the pre-hospital environment. Abstract published with permission.
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The paramedics' pledge: a short commentary on its inception and developmentThis article discusses the creation and evolution of a unifying pledge designed to encapsulate the identity of paramedics and convey the essence of belonging to this professional group. Abstract published with permission.
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Exploring paramedic professional identityThe notion of a paramedic (as a title protected in law) has recently entered its third decade, but the history of the paramedic is considerably older than that. Who are we as a profession? What does it mean to be a paramedic? What makes us who we are? These intriguing and yet seldom asked philosophical questions are at the heart of this article, which is intended to provoke discussion and serve as a foundation for further inquiry into questions of identity and philosophy in paramedicine. Literature pertaining to paramedic professional identity was explored and contextualised within current paramedic practice. Although the overall picture is complex, four key areas for discussion emerged: the history of the paramedic profession; role diversity; the influence of ambulance work; and the education and training of paramedics. The influence of ambulance work permeates all areas, suggesting that it is central to the development of paramedic professional identity. This discussion article is an exploration of the unique contexts and experiences that are associated with the process of being and becoming for paramedics. Abstract published with permission.
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α1-adrenoceptor antagonists and 5α-reductase inhibitors for urinary tract symptoms in benign prostatic hyperplasiaBenign prostatic hyperplasia is a condition that develops in the majority of men and is by some estimates is the most prevalent of all minor ailments. A healthily functioning prostate is important for the workings of the male reproductive and urinary systems. The most frequently prescribed first-line pharmacological treatments for lower urinary tract symptoms attributed to benign prostatic hyperplasia are α1-adrenoceptor antagonists and 5α-reductase inhibitors; surgery can also be carried out. Expert consensus and a strong body of evidence show these drugs are safe and effective. However, they come with a variety of side-effects so patients' priorities and lifestyles will influence pharmacological management. Abstract published with permission.
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Advance care planning virtually during a pandemicIntroduction The Marie Curie Virtual Advance Care Planning service was set up in response to the vulnerability of Care Home Residents during the Covid-19 crisis. Aims To evidence that Advance Care Planning can be effective and produce high quality plans even when not done face to face. Method Qualitative interviews with Nurses working on the service. Quantaitive data of numbers of plans created and views by London Ambulance Service. Results It is possible to have meaningful Advance Care Planning conversations virtually and record them electronically to be shared with multiple providers. Conclusion Marie Curie had existing experience of working with Care home staff and GPs to create CMC records. This experience was used to initiate and provide this virtual service across several areas in London involving Care Home residents. and the service has expanded to receive referrals from Hospital Consultants for their out-patients who they believe would benefit from advance care planning and the creation of a CMC record. Impact During the pandemic Marie Curie supported 1,361 new care plans and reviewed 313 existing care plans. The service has returned face to face in Ealing and is still going strong in North East London virtually. We are now looking at supporting Domiciliary Care agencies as well as Care Homes. https://spcare.bmj.com/content/12/Suppl_1/A12.1 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/
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Safety and efficacy of paramedic treatment of regular supraveentricular tachycardiaIntroduction Treatment of supraventricular tachycardia (SVT) with adenosine by paramedics has been investigated and proven to be safe in the USA, but patients (pts) are transferred to hospital. We hypothesised that paramedics can safely treat and discharge pts with regular SVT without transfer to an accident and emergency department and tested this in a randomised controlled trial. Methods Pts presenting with regular narrow complex tachycardia on 12 lead ECG who were heamodynamically stable, with no history of structural or ischaemic heart disease and without contraindication to adenosine were considered for enrolment. Pts were randomised to paramedic treatment (PARA) or admission to hospital (A&E). PARA pts received valsalva manoeuvre at the scene with subsequent administration of 6 mg and 12 mg of adenosine unless the SVT terminated. Pts were taken to A&E if the tachycardia did not terminate, restarted, or the patient (pt) had continuing symptoms, a persistently abnormal ECG (other than Twave inversion) or was heamodynamically unstable. Prior to discharge from the ambulance pts received an information pack and a referral letter for their GP to refer them to an arrhythmia clinic. Pts randomised to A&E were treated as normal and given no information other than that pertaining to the study. Results Of the 60 pts (33=F, age 52+/-19 years) enroled to date, 56% pts had previously attended A&E with palpitations. 2 pts withdrawn as lost to follow up. Results table 1 PARA discharge times were relatively long because 12 pts randomised to PARA were transported to A&E (5 did not terminate arrhythmia, 1 abnormal observations, 4 paramedic felt ECG abnormal (confirmed as minor abnormalitites by expert panel that would not require treatment), 2 abnormal ECG requiring treatment). A panel of 2 arrhythmia experts reviewed records for all PARA pts and confirmed treatment was appropriate for all but would have further assessed 1 pt with lung disease. Conclusions Paramedic treatment and discharge of pts with regular SVT is safe, efficacious and reduces admissions. Cost effectiveness analysis is ongoing. http://heart.bmj.com/content/99/suppl_2/A46.1.full.pdf+html?sid=0fb7e2f8-0ace-45ee-ba38-57a2777d5d31 https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed14&AN=71283783 https://libkey.io/libraries/2901/openurl?genre=article&sid=OVID:embase&id=pmid:&id=doi:10.1136%2Fheartjnl-2013-304019.71&issn=1355-6037&isbn=&volume=99&issue=SUPPL.+2&spage=A46&pages=A46&date=2013&title=Heart&atitle=Safety+and+efficacy+of+paramedic+treatment+of+regular+supraveentricular+tachycardia&aulast=Baker&pid=%3Cauthor%3EBaker+A.%3BWhitbread+M.%3BRichmond+L.%3BKirkby+C.%3BRobinson+G.%3BAntoniou+S.%3BSchilling+R.%3C%2Fauthor%3E%3CAN%3E71283783%3C%2FAN%3E%3CDT%3EConference+Abstract%3C%2FDT%3E 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/openhrt-2015-000281