• Focused cardiac ultrasound in out-of-hospital cardiac arrest: a literature review

      Brown, Nick; Quinn, Tom (2021-01-02)
      Focused 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.
    • Pre-hospital resuscitation: what shall we tell the family?

      Brown, Nick (2016-02)
      Abstract published with permission. Cardiac arrest is a rarely attended event as a proportion of overall paramedic workload. When paramedics do attend such an event the management focus is largely concerned with clinical intervention and there may not be the capacity or appreciation for offering ongoing support to family members present. Indeed, even training may not have covered this element of care. Regardless of the prognosis for the patient, evidence suggests that there is benefit in directly involving relatives during the resuscitation. Engaging them with carefully considered and informed dialogue certainly seems humane at least. In which case, a structured and holistic approach should be employed where clinical care and emotional support go hand in hand.
    • Should the Kendrick Extrication Device have a place in pre-hospital care?

      Brown, Nick (2015-06)
      Abstract published with permission. The Kendrick Extrication Device (KED) is described as an ‘emergency patient handling device designed to aid in the immobilisation and short transfer movement of patients with suspected spinal/cervical injuries’ (Ferno-Washington, 2001).The device that evolved in the late 1970s was originally intended to assist with the immobilisation and extrication of racing drivers from their cockpit (American Academy of Orthopaedic Surgeons et al, 2012;Trafford et al, 2014). Since then it has become adopted by many ambulance services as a tool intended to assist in the immobilisation and extrication of patients, particularly from road traffic collisions (RTC) and is a recognised piece of equipment among paramedics. However, its assimilation into the pre-hospital environment and overall appropriateness in patient care should be viewed with caution. This article comments on the potential adverse risks associated around delayed extrication, the impact on respiratory function and the potential for increased movement of the casualty. Additionally, it highlights the current lack of evidence to support its use.