• Choking in London

      Pavitt, Matthew J.; Nevett, Joanne; Swanton, Laura L.; Hind, Matthew; Polkey, Michael I.; Green, Malcolm; Hopkinson, Nicholas S. (2017-09)
    • Exploratory analysis on the need for an ECMO eCPR service in South East London

      Auzinger, G.; Best, T.; Gelandt, E.; Hurst, T.; Kakar, V.; Loveridge, R.; Morgan, L.; Nevett, Joanne; Park, C.; Patel, S.; et al. (2016-11)
    • Impact of Early (≤24 H) Versus Delayed (>24 H) Intervention in Patients With non-ST Segment Elevation Myocardial Infarction: An Observational Study of 20,882 Patients From the London Heart Attack Group

      Panoulas, Vasileios; Rathod, Krishnaraj S.; Jain, Ajay K.; Firoozi, Sam; Nevett, Joanne; Kalra, Sundeep Singh; Malik, Iqbal S.; Mathur, Anthony; Redwood, Simon; MacCarthy, Philip A.; et al. (2020-06-03)
    • London ambulance source data on choking incidence for the calendar year 2016: an observational study

      Pavitt, Matthew J.; Nevett, Joanne; Swanton, Laura L.; Hind, Matthew; Polkey, Michael I.; Green, Malcolm; Hopkinson, Nicholas S. (2017-12)
      Introduction Complete foreign body airway obstruction is a life-threatening emergency, but there are limited data on its epidemiology. Methods We conducted a retrospective analysis of data collected routinely from London Ambulance Service calls coded as being for choking was undertaken for the calendar year of 2016. Results There were 1916 choking episodes of significant severity to call for emergency assessment in London during 2016, 0.2% of total calls requiring an ambulance response, an average of 5.2 per day. The incidence increased at the extremes of age. Calls coded as choking occurred at times consistent with lunch and dinner and less frequently at breakfast. Peak incidence occurred at Sunday lunchtimes and on Wednesday evenings. Conclusions Choking is a substantial health problem for Londoners to seek emergency assistance. Choking is more frequent at the extremes of age with a higher incidence at lunch and dinner time. Greater public awareness of choking and its management could help to prevent avoidable deaths. https://bmjopenrespres.bmj.com/content/4/1/e000215 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/bmjresp-2017-000215
    • Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group

      Rathod, Krishnaraj S.; Jain, Ajay K.; Firoozi, Sam; Lim, Pitt; Boyle, Richard; Nevett, Joanne; Dalby, Miles C.; Kalra, Sundeep S.; Malik, Iqbal S.; Sirker, Alexander; et al. (2020-03-20)
    • A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2

      Pareek, Nilesh; Kordis, Peter; Beckley-Hoelscher, Nicholas; Pimenta, Dominic; Kocjancic, Spela Tadel; Jazbec, Anja; Nevett, Joanne; Fothergill, Rachael; Kalra, Sandeep; Lockie, Tim; et al. (2020-12)
    • A randomised tRial of Expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: The ARREST pilot randomised trial

      Patterson, Tiffany; Perkins, Gavin D.; Joseph, Jubin; Wilson, Karen; Van Dyck, Laura; Robertson, Steven; Nguyen, Hanna; McConkey, Hannah; Whitbread, Mark; Fothergill, Rachael; et al. (2017-06)
    • A randomised trial of expedited transfer to a cardiac arrest centre for non-ste out-of-hospital cardiac arrest: arrest

      Patterson, Tiffany; Perkins, Gavin D.; Joseph, Jubin; Wilson, Karen; Van Dyck, Laura; Robertson, Steven; Nguyen, Hanna; McConkey, Hannah; Whitbread, Mark; Fothergill, Rachael; et al. (2018-01)
      Background Wide variation exists in inter-hospital survival from OHCA. Regionalisation of care into cardiac arrest centres (CAC) may improve this. We report a pilot randomised trial of expedited transfer to a CAC following OHCA without ST-elevation. The objective was to assess the feasibility of performing a large-scale RCT. Methods Adult witnessed VF OHCA of presumed cardiac cause were randomised 1:1 to either: (1) intervention: expedited transfer to a CAC for goal-directed therapy including access to immediate reperfusion, or (2) control: current standard of care involving delivery to the geographically closest hospital. The feasibility of randomisation, protocol adherence and data collection of the primary (30 day all-cause mortality) and secondary (cerebral performance category (CPC)) and in-hospital major cardiovascular and cerebrovascular events (MACCE) clinical outcome measures were assessed. Results Between Nov 2014 and April 2016, 118 cases were screened, of which 63 patients (53%) met eligibility criteria and 40 of the 63 patients (63%) were randomised. There were no protocol deviations in the treatment arm. Data collection of primary and secondary outcomes was achieved in 83%. There was no difference in baseline characteristics between the groups: 30 day mortality (Int 9/18, 50% vs Control 6/15, 40%; p=0.73), CPC 1/2 (Int: 9/18, 50% vs Control 7/14, 50%; p>0.99) or MACCE (Int: 9/18, 50% vs Control 6/15, 40%; p=0.73). Conclusions These findings support the feasibility of conducting a large-scale RCT to address a remaining uncertainty in post-arrest care. https://heart.bmj.com/content/104/Suppl_1/A7.2 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/heartjnl-2018-BCIS.13
    • Rationale and design of: A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomized controlled trial

      Patterson, Tiffany; Perkins, Alexander; Perkins, Gavin D.; Clayton, Tim; Evans, Richard; Nguyen, Hanna; Wilson, Karen; Whitbread, Mark; Hughes, Johanna; Fothergill, Rachael; et al. (2018-10)
    • Using London Ambulance Service activity as a metric for quality improvement in asthma, assessment of activity data

      Sriskandakumar, S.; Nevett, Joanne; Virdi, Gurkamal K.; Iles, R. (2017-05)
      Aim The Healthy London Partnership (HLP) aims to improve quality of care in the capital, with a focus on children and young people, who face some of the poorest health outcomes compared with the rest of the country. Using the distribution of paediatric asthma emergency calls to London Ambulance Service (LAS) as a metric, and the HLP Asthma toolkit, we can assess the impact of our findings. Methods We gathered data from the LAS for all asthma related calls during the period of 01/01/2015 to 01/01/2016 regarding paediatric calls, ages 0–19 years. Data was analysed with attention to the distribution of calls against time, gender and conveyance to hospital. Results In the period analysed, there were a total of 10 498 asthma calls to the LAS, where 80.53% of calls were conveyed to Emergency Departments (EDs). 2946 (28.06%) were made from the 0 to 19 years age group. In the 0 to 4 years age group, 68.52% of calls were for males, to 31.48% of females in the same age group (5.39% to 2.47% respectively of all calls). There is a greater incidence of calls from males until 15 years, later more are from females. From the total number of calls, 5829 (55.52%) were made for females, with the highest incidence in September (9.94%). Weekly analysis shows most calls are made on Monday (15.91%), the busiest times are between 10am– 12pm, and from 7 pm to midnight. The data presented is generic, not specific to the location or severity of calls, but it can facilitate whole system changes. Conclusions Age, gender and time distribution of calls to the LAS provide a useful metric to enable strategies for a London-wide system change. This can be assessed using the HLP toolkit, which has provided examples of good practise and audit strategies, accessible to all healthcare providers. The data from our research can improve asthma education to parents, teachers and carers, and highlight areas for improvement. This ensures everyone involved in asthma care can benefit from the findings of our research. https://adc.bmj.com/content/102/Suppl_1/A9.3 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/archdischild-2017-313087.21
    • Using patient specific protocols (PSP) to achieve appropriate oxygenation in patients at risk of oxygen toxicity; from ambulance through to inpatient stay

      Toshner, R.J.; Vaghela, A.; Nevett, Joanne; Resrick, L.J. (2018-12)
      Introduction and objectives The London Ambulance Service(LAS) uses Patient Specific Protocols(PSPs) as directives for a range of conditions. Since 20061 we have worked with LAS using PSPs to prevent oxygen(O2) toxicity during ambulance transfer in patients at risk of type 2 respiratory failure. PSPs are now ‘flagged’ on our records which may also influence hospital oxygen prescribing. The aim of this study was to evaluate PSP effectiveness in influencing appropriate O2 prescribing during both ambulance transfer and hospital stay. Methods Data from 50 patients identified as at risk of oxygen toxicity(disease severity and/or raised bicarbonate) who had PSPs initiated sequentially pre-May 2017 were reviewed for; initiation bicarbonate, ED attendances, prescription and delivery of O2 in ambulance/ED/wards, and death in the subsequent year. Results Hospital records were reviewed for 43/50 (86%) patients with PSPs. Patient characteristics are shown in table 1. In the year post-PSP 20/43 (46.5%) had ≥1 hospital attendance (overall 44 attendances); there were 2 deaths(not O2-related). LAS data were available for 34/44 (77%) attendances. 30/34 (88.2%) were appropriately oxygenated during ambulance transfer. 4/34 (11.8%) had saturations above target range; of these, 2/4 had immediate action taken. In ED 34/34 (100%) patients had documented alert of O2 sensitivity and 34/40 (85%) had appropriate oxygenation. 5/40 (12.5%) had saturations above target range and 1/40 (2.5%) saturations below range; of these, 4/6 had corrective action taken to restore saturations towards target range. 21/34 (61.8%) had specified O2 prescription in ED. On ward transfer, 34/36 (94%) had saturations in range; 1/36 (2.7%) above target range, with corrective action not taken and 1/36 (2.7%) below target, with corrective action taken. 32/34 (94.1%) had ward O2 prescriptions. Conclusions PSPs continue to be an effective mechanism for ensuring safe oxygenation during ambulance transfer of at risk patients. Patients were identified appropriately for PSP; almost half were admitted in the subsequent year. Having a PSP flagged on their records also enabled safe O2 prescription and delivery from arrival in ED through to inpatient wards. While PSPs are an agreed Londonwide Ambulance tool to prevent oxygen toxicity, their impact on patient safety appears to be far wider reaching than ambulance transfer. https://thorax.bmj.com/content/73/Suppl_4/A198.2 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/thorax-2018-212555.337