RSS 1.0Publications - London Ambulance Service
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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
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Never struggle aloneThis shift started like every other and after a couple of jobs, we were on our way to hospital for a category 2 interfacility transfer. However, no less than a mile away from our last job, the stand down alert came through as we were changed to a category 1. The sat nav re-routed to the new location as my crew mate read out the words no one wants to hear: 'Katy, it’s a paediatric arrest'. What went through my mind at that moment is not for the printed page, but a gamut of emotions was flowing. Multiple alerts were pinging through, and control was radioing us. Abstract published with permission
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Baptism of fireHaving spent 5 weeks on operational placement, Katy Sofield describes her ‘baptism of fire’. Abstract published with permission.