• Ambulance clinician assessment and management of transient loss of consciousness: a retrospective clinical audit

      Shaw, Joanna; Ulrich, Alex; Fothergill, Rachael; Whitbread, Mark (2016-01)
      Abstract published with permission. Introduction: Transient loss of consciousness (T-LOC) is thought to be underestimated and under-managed in the pre-hospital setting. This clinical audit aims to assess the compliance of ambulance clinicians against the National Institute of Clinical Excellence guidance on the management of patients with T-LOC. Method: Ninety-four patients’ clinical records and electrocardiograms (ECGs) were reviewed to determine appropriateness of assessment and patient management. Results: In this limited sample, findings show standard assessments and history documented for all patients were equally well recorded for T-LOC patients, but those specific to T-LOC were not. The number of ECGs conducted and interpreted correctly was an additional area of concern. Conclusions: Further assessments and history specific to T-LOC are required in the pre-hospital setting to ensure any potentially serious causes are recognised and these patients are taken to hospital.
    • Ambulance identification score for ruptured abdominal aortic aneurysm

      Karthikesalingam, Alan; Fothergill, Rachael; Holt, P.; Patterson, B.; Vidal-Diez, A. (2016-07)
    • Ambulance response times and mortality in elderly fallers

      Cannon, Emily; Shaw, Joanna; Fothergill, Rachael; Lindridge, Jaqualine (2016-09)
      Background Worldwide, the number of people aged over 60 is growing faster than any other age group. Increased age is associated with a higher risk of falling and roughly a third of individuals aged 65 and over experience a fall each year. One way in which ambulance services may impact the outcome of patients is the time taken for a response to arrive on scene. Lying on the floor for a long time has been found to be strongly associated with serious injuries, admission to hospital, and mortality. However, previous research has not assessed the impact of ambulance response times on mortality. Methods To determine whether there is a relationship between the time elderly fallers (aged 65 and over) spend on the floor and mortality, an observational study was undertaken. A convenience sample of 503 ambulance response times, patient records detailing the amount of time spent on the floor, and patient outcomes at 90 days were analysed using logistic regression. Results Eight percent of patients in the sample died within 90 days of their fall (n=38). Patients who were deceased at 90-day follow-up (n=38) did not wait significantly longer for an ambulance than patients who were still alive (n=464) (means= 34 min vs 37 min, p=.678). Of the patients who were still on the floor upon LAS arrival (n=178), those who had died within 90 days following their fall (n=14) spent less time in total on the floor than patients who were still alive at 90-day follow-up (n=164) (means= 59 min vs 98 min, p=.296). Conclusions Increased ambulance response time or prolonged time spent on the floor was not associated with 90-day mortality in elderly fallers who presented to the ambulance service. Whilst any delays in attending elderly fallers require monitoring, we can be reassured that long waits are not leading to mortality in this patient group. https://emj.bmj.com/content/emermed/33/9/e9.1.full.pdf 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/ http://dx.doi.org/10.1136/emermed-2016-206139.29
    • Ambulance smartphone tool for field triage of ruptured aortic aneurysms (FILTR): study protocol for a prospective observational validation of diagnostic accuracy

      Lewis, Thomas L.; Fothergill, Rachael; Aneurysm-FILTR Study Group; Karthikesalingam, Alan (2016-10)
      Introduction: Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre. Methods and analysis: Prospective multicentre observational study assessing the diagnostic accuracy of a prehospital smartphone triage tool for detection of rAAA. The study will be conducted across London in conjunction with London Ambulance Service (LAS). A logistic score predicting the risk of rAAA by assessing ten key parameters was developed and retrospectively validated through logistic regression analysis of ambulance records and Hospital Episode Statistics data for 2200 patients from 2005 to 2010. The triage tool is integrated into a secure mobile app for major smartphone platforms. Key parameters collected from the app will be retrospectively matched with final hospital discharge diagnosis for each patient encounter. The primary outcome is to assess the sensitivity, specificity and positive predictive value of the rAAA triage tool logistic score in prospective use as a mob app for prehospital ambulance clinicians. Data collection started in November 2014 and the study will recruit a minimum of 1150 non-consecutive patients over a time period of 2 years. Ethics and dissemination: Full ethical approval has been gained for this study. The results of this study will be disseminated in peer-reviewed publications, and international/national presentations https://bmjopen.bmj.com/content/6/10/e011308.long 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/ http://dx.doi.org/10.1136/bmjopen-2016-011308
    • Attitudes to cardiopulmonary resuscitation and defibrillator use: a survey of UK adults in 2017

      Hawkes, Claire A.; Brown, Terry P.; Booth, Scott; Fothergill, Rachael; Siriwardena, Aloysius; Zakaria, Sana; Askew, Sara; Williams, Julia; Rees, Nigel; Ji, Chen; et al. (2019-04)
    • Attitudes to CPR and public access defibrillation: A survey of the UK public

      Hawkes, Claire A.; Booth, Scott; Brown, Terry P.; Fothergill, Rachael; Zakaria, Sana; Askew, Sara; Siriwardena, Aloysius; Williams, Julia; Rees, Nigel; Perkins, Gavin D. (2017-09)
    • Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review

      Smith, Christopher M.; Lim Choi Keung, Sarah N.; Khan, Mohammed O.; Arvanitis, Theodoros N.; Fothergill, Rachael; Hartley-Sharpe, Christopher; Wilson, Mark H.; Perkins, Gavin D. (2017-10)
    • Barriers to Automated External Defibrillation in a volunteer first-responder system

      Smith, Christopher M.; Griffiths, Frances; Hartley-Sharpe, Christopher; Fothergill, Rachael; Wilson, Mark H.; Perkins, Gavin D. (2018-09)
    • Bystander cardiopulmonary resuscitation: Impact of training initiatives

      Brown, Terry P.; Booth, Scott; Lockey, Andrew S.; Askew, Sara; Hawkes, Claire A.; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Gunson, Imogen; Soar, Jasmeet; et al. (2018-09)
    • Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration?

      Shaw, Joanna; Fothergill, Rachael; Clark, Sophie; Moore, Fionna (2017-08)
      Introduction The National Early Warning Score (NEWS) aids the early recognition of those at risk of becoming critically ill. NEWS has been recommended for use by ambulance services, but very little work has been undertaken to date to determine its suitability. This paper examines whether a prehospital NEWS derived from ambulance service clinical observations is associated with the hospital ED disposition. Methods Prehospital NEWS was retrospectively calculated from the ambulance service clinical records of 287 patients who were treated by the ambulance service and transported to hospital. In this cohort study, derived NEWS scores were compared with ED disposition data and patients were categorised into the following groups depending on their outcome: discharged from ED, admitted to a ward, admitted to intensive therapy unit (ITU) or died. Results Prehospital NEWS-based ambulance service clinical observations were significantly associated with discharge disposition groups (p<0.001), with scores escalating in line with increasing severity of outcome. Patients who died or were admitted to ITU had higher scores than those admitted to a ward or discharged from ED (mean NEWS 7.2 and 7.5 vs 2.6 and 1.7, respectively), and in turn those who were admitted to a ward had higher pre-hospital NEWS than those who were discharged (2.6 vs 1.7). Conclusion Our findings suggest that the NEWS could successfully be used by ambulance services to identify patients most at risk from subsequent deterioration. The implementation of this early warning system has the potential to support ambulance clinician decision making, providing an additional tool to identify and appropriately escalate care for acutely unwell patients https://emj.bmj.com/content/emermed/34/8/533.full.pdf 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/ http://dx.doi.org/10.1136/emermed-2016-206115
    • Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Soar, Jasmeet; Mark, Julian; Mapstone, James; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Bichmann, Anna; et al. (2019-01-01)
    • Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

      Fothergill, Rachael; Williams, Julia; Edwards, Melanie J.; Russell, Ian T.; Gompertz, Patrick (2013-11)
    • The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials

      Perkins, Gavin D.; Kenna, Claire; Ji, Chen; Deakin, Charles D.; Nolan, Jerry P.; Quinn, Tom; Fothergill, Rachael; Gunson, Imogen; Pocock, Helen; Rees, Nigel; et al. (2019-07)
    • Epidemiology and outcomes from out-of-hospital cardiac arrests in England

      Hawkes, Claire A.; Booth, Scott; Ji, Chen; Brace-McDonnell, Samantha J.; Whittington, Andrew; Mapstone, James; Cooke, Matthew W.; Deakin, Charles D.; Gale, Chris P.; Fothergill, Rachael; et al. (2017-01)
    • Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

      Edwards, Melanie J.; Bassett, Gary; Sinden, Levi; Fothergill, Rachael (2015-05)
      Background A minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients. Objectives The present study aimed to (i) profile frequent callers to the ambulance service and (ii) evaluate the impact of a case management interventional approach on frequent caller behaviour. Methods A retrospective review of data from a 2-year period (from 1 April 2009 to 31 March 2011) was conducted. Patients were included in the analysis if they had been accepted for case management intervention by the Patient-Centred Action Team during this period and met the study inclusion criteria. Results The review identified 110 frequent callers who met the study inclusion criteria. The majority of frequent callers (86%) had multiple and complex reasons for calling, including frequent medical need, acute or chronic mental health condition, older age and unmet personal or social care needs. In the majority of cases (82%), multiple interventional strategies were required. A significant reduction in median call volume was observed from preintervention to postintervention (from five calls/month to zero calls/month). Conclusions Effective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour. https://emj.bmj.com/content/32/5/392.long 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/ http://dx.doi.org/10.1136/emermed-2013-203496
    • Genuine illness and injury during Europe’s largest emergency service major incident exercise

      Cannon, Emily; Edwards, Timothy; Fothergill, Rachael (2017-05)
      Aim Previous studies of patient presentation rates at mass gatherings have been limited to social events. None have assessed presentation rates in the context of a large-scale emergency service exercise where individuals (actors playing hypothetical casualties) are exposed to an environment containing many potential hazards. Methods Exercise Unified Response was the largest multi-agency exercise ever held in Europe. It was a four-day major incident exercise in the UK, in which 2700 individuals acted as casualties. Clinical records completed by healthcare professionals providing on-site medical cover for the duration of the event were reviewed. Clinical records were included where the individual’s role in the exercise was listed as ‘actor’. Results Thirty actors required medical attention, giving a patient presentation rate (PPR) of 11.1 per one thousand actors. Of these, 10% were conveyed to hospital with musculoskeletal (n=2) or head injuries (n=1); an ambulance transfer rate (ATR) of 1.11 per 1000. Just under half of all patients (40%, n=12) had a contributory factor to seeking medical help, where they had: not eaten on the day (n=4); a pre-existing condition exacerbated by the exercise, such asthma (n=3); pre-existing symptoms of acute illness (n=3), or a pre-existing injury (n=2). Conclusion Patient presentation rate was in line with previous research1. However, we believe this is the first study to report similar data for a mass emergency service exercise. Our findings regarding the factors and pre-existing illnesses/conditions that contributed to individuals seeking medical help will be valuable in planning future large-scale exercises. https://bmjopen.bmj.com/content/7/Suppl_3/A3.2 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/ http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.8
    • Identification of characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates

      Brown, Terry P.; Hawkes, Claire A.; Booth, Scott; Fothergill, Rachael; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Benger, Jonathan; et al. (2017-09)
    • Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model.

      Koniotou, Marina; Evans, Bridie A.; Chatters, Robin; Fothergill, Rachael; Garnsworthy, Christopher; Gaze, Sarah; Halter, Mary; Mason, Suzanne; Peconi, Julie; Porter, Alison; et al. (2015-07)