RSS 1.0Publications - London Ambulance Service
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Community emergency medicine: taking the ED to the patient: a 12-month observational analysis of activity and impact of a physician response unitInternational and national health policies advocate greater integration of emergency and community care. The Physician Response Unit (PRU) responds to 999 calls 'taking the Emergency Department to the patient'. Operational since 2001, the service was reconfigured in September 2017. This article presents service activity data and implications for the local health economy from the first year since remodelling. METHODS: A retrospective descriptive analysis of a prospectively maintained database was undertaken. Data collected included dispatch information, diagnostics and treatments undertaken, diagnosis and disposition. Treating clinical teams recorded judgments whether patients managed in the community would have been (1) conveyed to an emergency department (ED)and (2) admitted to hospital, in the absence of the PRU. Hospital Episode Statistics data and NHS referencing costs were used to estimate the monetary value of PRU activity. RESULTS: 1924 patients were attended, averaging 5.3 per day. 1289 (67.0%) patients were managed in the community. Based on the opinion of the treating team, 945 (73.3%) would otherwise have been conveyed to hospital, and 126 (9.7%) would subsequently have been admitted. The service was estimated to deliver a reduction of 868 inpatient bed days and generate a net economic benefit of £530 107. CONCLUSIONS: The PRU model provides community emergency medical care and early patient contact with a senior clinical decision-maker. It engages with community providers in order to manage 67.0% of patients in the community. We believe the PRU offers an effective model of community emergency medicine and helps to integrate local emergency and community providers., https://www.ncbi.nlm.nih.gov/pubmed/31857371. 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: 10.1136/emermed-2018-208394
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Community emergency medicine: taking the ED to the patient: a 12-month observational analysis of activity and impact of a physician response unitInternational and national health policies advocate greater integration of emergency and community care. The Physician Response Unit (PRU) responds to 999 calls ‘taking the Emergency Department to the patient’. Operational since 2001, the service was reconfigured in September 2017. This article presents service activity data and implications for the local health economy from the first year since remodelling. https://emj.bmj.com/content/37/9/530 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/emermed-2018-208394
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Human factors within paramedic practice: the forgotten paradigmIt would seem hard to imagine how you could draw a comparison between a commercial airline pilot struggling to land a stricken plane in a storm and a paramedic fighting to save the life of a patient in cardiac arrest. Although very different circumstances, they both have one thing in common: that is, they are both vulnerable to a condition known as ‘the human factor’. Examples of where Human Factors (HFs) exist within the prehospital profession can be various, common examples are environmental distractions e.g. noise from bystanders, mobile phones, machines, or more simply caused by lack of sleep and inadequate nourishment. This article discusses human factors within the prehospital environment and will highlight the benefits of being able to recognize and act upon them, with a specific focus upon the impact they can have on the ambulance practitioner operating in the field. It discusses human factors training and recognizes the role of crew resource management (CRM) and its importance within the prehospital profession. Abstract published with permission.
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The current leadership development opportunities provided for student paramedics by Higher Education Institutions: a literature reviewIntroduction: The development of safe, competent and capable paramedics is one of the key concerns of education providers or Higher Education Institutions (HEIs). To achieve this, paramedic programmes need to focus on teaching leadership to students. The aim of this literature review was to identify the current leadership development opportunities for paramedic students during their undergraduate training across the United Kingdom, in order to identify current gaps and make suggestions on how HEIs could increase leadership opportunities for student paramedics. Methods: During August 2018, the Scopus, Medline, CINAHL and Academic Search Premier databases were searched (the last three accessed via EBSCOhost). Grey literature was also manually reviewed. Both authors screened the title and abstract and agreed on final papers eligible for full-text review. CASP and COREQ checklists were used to assist in critically appraising the quality of the research and to help decide on the papers chosen for inclusion. Results: The search yielded 511 results (455 after duplicates were removed). The grey literature search also yielded one additional document that incorporated a framework based on primary research integrated within the paper itself. After title and abstract review, seven papers were included for full text critical review. Two papers were then excluded, resulting in a total of five papers being included in the review. Conclusion: Current evidence, although limited, demonstrates the benefit of educational programmes in developing educational and non-educational leadership opportunities for paramedic students. Moreover, there is value to individuals being provided or seeking extra-curricular activities, and students should be encouraged to engage in societies, the College of Paramedics, events and conferences, and to work or volunteer in healthcare or emergency service-related sectors to further enhance their leadership potential and skills. Abstract published with permission.
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Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literatureIntroduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. Abstract published with permission.
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Focused cardiac ultrasound in out-of-hospital cardiac arrest: a literature reviewFocused cardiac ultrasound (FoCUS) is emerging in emergency medical systems, particularly in the context of prognostication in out-of-hospital cardiac arrest. However, FoCUS has not been formally incorporated into UK guidelines because of a lack of evidence. Furthermore, concerns have been raised that FoCUS can distract people from providing other essential and evidenced elements of care. This broad literature search aims to shed light on the practice of FoCUS in cardiac arrest by reviewing articles related to in-hospital and out-of-hospital practice. The findings are conspicuous by the lack of high-quality studies, particularly regarding prognostication. Association between ultrasound findings and outcome are asserted, as is the feasibility of paramedic use of FoCUS, although the evidence is from small and non-randomised studies and subject to bias. Abstract published with permission.
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Descriptive record of the activity of military critical care transfer teams deployed to London in 20 April to undertake transfer of patients with COVID-19In the face of the COVID-19 outbreak, military healthcare teams were deployed to London to assist the London Ambulance Service t transfer ventilated patients between medical facilities. This paper describes the preparation and activity of these military teams, records the lessons identified (LI) and reviews the complications encountered’. The teams each had two members. A consultant or registrar in emergency medicine (EM) and pre-hospitalemergency medicine (PHEM)E or anaesthesia and an emergency nurse or paramedic. Following a period of training, the teams undertook 52 transfers over a 14-day period. LI centred around minimising both interruption to ventilation and risk of aerosolisation of infectious particles and thus the risk of transmission of COVID-19 to the treating clinicians. Three patient-related complications (6% of all transfers) were identified. This was the first occasion on which the Defence Medical Services (DMS) were the main focus of a large-scale clinical military aid to the civil authorities. It demonstrated that DMS personnel have the flexibility to deliver a novel effect and the ability to seamlessly and rapidly integrate with a civilian organisation. It highlighted some clinical lessons that may be useful for future prehospital emergency care taskings where patients may have a transmissible respiratory pathogen. It also showed that clinicians from different backgrounds are able to safely undertake secondary transfer of ventilated patients. This approacmay enhance flexibility in future operational patient care pathways. https://militaryhealth.bmj.com/content/early/2020/12/28/bmjmilitary-2020-001619 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/bmjmilitary-2020-001619
