• Accuracy of emergency medical dispatchers' subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol's recommended coding based on paramedic outcome data

      Clawson, Jeff; Olola, Christopher H.O.; Heward, Andy; Scott, Greg; Patterson, Brett (2007-08)
      To establish the accuracy of the emergency medical dispatcher’s (EMD’s) decisions to override the automated Medical Priority Dispatch System (MPDS) logic-based response code recommendations based on at-scene paramedic-applied transport acuity determinations (blue-in) and cardiac arrest (CA) findings. https://emj.bmj.com/content/24/8/560. 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/emj.2007.047928.
    • Airway management in UK ambulance services: where are we now?

      George, Jason; Smith, Joanne; Moore, Fionna (2012-06)
    • Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices

      Bowles, Christopher T.; Hards, Rachel; Wrightson, Neil; Lincoln, Paul; Kore, Shishir; Marley, Laura; Dalzell, Jonathan R.; Raj, Binu; Baker, Tracey A.; Goodwin, Diane; et al. (2017-12)
      Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients. https://emj.bmj.com/content/emermed/34/12/842.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-2016-206172
    • 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
    • Aspirin administration by emergency medical dispatchers using a protocol-driven aspirin diagnostic and instruction tool

      Barron, Tracey; Clawson, Jeff; Scott, Greg; Patterson, Brett; Shiner, Ronald; Robinson, Donald; Wrigley, Fenella; Gummett, James; Olola, Christopher H.O. (2013-07)
      Background The American College of Cardiology and the American Heart Association recommend early aspirin administration to patients with symptoms of acute coronary syndrome (ACS)/acute myocardial infarction (AMI). The primary objective of this study was to determine if Emergency Medical Dispatchers (EMD) can provide chest pain/heart attack patients with standardised instructions effectively, using an aspirin diagnostic and instruction tool (ADxT) within the Medical Priority Dispatch System (MPDS) before arrival of an emergency response crew. Methods This retrospective study involved three dispatch centres in the UK and USA. We analysed 6 months of data involving chest pain/heart attack symptoms taken using the MPDS chest pain and heart problems/automated internal cardiac defibrillator protocols. Results The EMDs successfully completed the ADxT on 69.8% of the 44 141 cases analysed. The patient's mean age was higher when the ADxT was completed, than when it was not (mean±SD: 53.9±19.9 and 49.9±20.2; p<0.001, respectively). The ADxT completion rate was higher for second-party than first-party calls (70.3% and 69.0%; p=0.024, respectively). A higher percentage of male than female patients took aspirin (91.3% and 88.9%; p=0.001, respectively). Patients who took aspirin were significantly younger than those who did not (mean±SD: 61.8±17.5 and 64.7±17.9, respectively). Unavailability of aspirin was the major reason (44.4%) why eligible patients did not take aspirin when advised. Conclusions EMDs, using a standardised protocol, can enable early aspirin therapy to treat potential ACS/AMI prior to responders' arrival. Further research is required to assess reasons for not using the protocol, and the significance of the various associations discovered. https://emj.bmj.com/content/emermed/30/7/572.full.pdf URL 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-2012-201339
    • 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
    • Can the provision of alternative transport arrangements increase the availability of emergency ambulances?

      Hayes, B.; Casson, D.; Lawrence, N.; Carroll, K.; Whitter, B.; Hartley-Sharpe, C. (2006-12)
      With increased licensing hours and the rise in the much publicised binge-drinking culture, the London Ambulance Service is finding itself stretched to the point that patients with serious illnesses or injuries are at risk of not receiving the response that they need. https://emj.bmj.com/content/23/12/e68.info. 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/emj.2006.041574
    • Community emergency medicine: taking the ED to the patient: a 12-month observational analysis of activity and impact of a physician response unit

      Kirby, Oliver; Greenhalgh, Rob; Goodsman, Dane; Davies, Gareth; Joy, Tony; Ramage, Lisa; Mitchinson, Sophie
      International 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
    • Community emergency medicine: taking the ED to the patient: a 12-month observational analysis of activity and impact of a physician response unit

      Joy, Tony; Ramage, Lisa; Mitchinson, Sophie; Kirby, Oliver; Greenhalgh, Rob; Goodsman, Dane; Davies, Gareth (2020-09)
      International 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
    • Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances

      Schumacher, Jan; Gray, Stuart A.; Weidelt, L.; Brinker, Andrea; Prior, K.; Stratling, W. M. (2009-06-22)
      Background: Advanced life support of patients contaminated with chemical, biological, radiological or nuclear (CBRN) substances requires adequate respiratory protection for medical first responders. Conventional and powered air-purifying respirators may exert a different impact during resuscitation and therefore require evaluation. This will help to improve major incident planning and measures for protecting medical staff. Methods: A randomised crossover study was undertaken to investigate the influence of conventional negative pressure and powered air-purifying respirators on the simulated resuscitation of casualties contaminated with hazardous substances. Fourteen UK paramedics carried out a standardised resuscitation algorithm inside an ambulance vehicle, either unprotected or wearing a conventional or a powered respirator. Treatment times, wearer mobility, ease of communication and ease of breathing were determined and compared. Results: In the questionnaire, volunteers stated that communication and mobility were similar in both respirator groups while breathing resistance was significantly lower in the powered respirator group. There was no difference in mean (SD) treatment times between the groups wearing respiratory protection and the controls (245 (19) s for controls, 247 (17) s for conventional respirators and 250 (12) s for powered respirators). Conclusions: Powered air-purifying respirators improve the ease of breathing and do not appear to reduce mobility or delay treatment during a simulated resuscitation scenario inside an ambulance vehicle with a single CBRN casualty. https://emj.bmj.com/content/26/7/501. 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 http://dx.doi.org/10.1136/emj.2008.061531
    • Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study

      Halter, Mary; Vernon, Susan; Snooks, Helen; Porter, Alison; Close, Jacqueline; Moore, Fionna; Porsz, Simon (2011-01)
      BACKGROUND: Older people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decision-making processes of emergency ambulance staff with older people who have fallen. METHODS: During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. RESULTS: The interviews revealed a similar assessment and decision-making process among participants: Prearrival: forming an early opinion from information from the emergency call. Initial contact: assessing the need for any immediate action and establishing a rapport. Continuing assessment: gathering and assimilating medical and social information. Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. CONCLUSIONS: An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance. https://emj.bmj.com/content/emermed/28/1/44.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/emj.2009.079566
    • Complications associated with supraglottic airway use in an urban ambulance service: a case series

      Edwards, Timothy (2016-09)
      Background Current resuscitation guidelines deemphasise the role of endotracheal intubation (ETI) in cardiac arrest. Although supraglottic airways (SGA) are increasingly used in the management of prehosptial cardiac arrest, there is limited data relating to adverse events in practice. Methods Cases reported to an ambulance service medical directorate involving adverse events associated with SGA use in cardiac arrest were logged from April 2014–October 2015. Prehospital clinical notes were reviewed to determine patient demographics, details of adverse events, clinical course and patient disposition. Results A total of 6 cases were reported. All patients were male and aged between 35–83 years. The majority of cases (n=4) were associated with a history of choking and the supraglottic device was removed to facilitate ETI due to poor ventilation. In all these cases, laryngoscopy revealed the presence of food obscuring the glottis which was removed under direct vision. None of these patients presented in a shockable rhythm and 3 experienced sustained return of spontaneous circulation. In another case, insertion of the supraglottic airway resulted in traumatic avulsion of teeth necessitating direct removal under laryngoscopy. This patient presented in ventricular fibrillation following chest pain and achieved ROSC at the scene. The final case involved a 35 years male with an extensive history of deliberate self-harm who received ventilation via SGA throughout the resuscitation attempt. A plastic bag was found compacted into the airway at post mortem. Conclusions The majority of adverse events associated with SGA use in cardiac arrest related to airway obstruction following choking. ROSC in a number of these patients suggests this may have been a reversible cause of cardiac arrest. Future guidelines should emphasise the need for laryngoscopy to exclude foreign body airway obstruction prior to SGA insertion in appropriate cases. https://emj.bmj.com/content/emermed/33/9/e8.2.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-2016-206139.27
    • A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008

      Deakin, Charles D.; Clarke, Tom; Nolan, Jerry P.; Zideman, David; Gwinnutt, Carl; Moore, Fionna; Keeble, Carl; Blancke, Wim (2010-03)
      Paramedic tracheal intubation has been practised in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcomes. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate, and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (eg, laryngeal mask airway), which were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative prehospital airway device for paramedics. https://emj.bmj.com/content/27/3/226.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/ DOI http://dx.doi.org/10.1136/emj.2009.082115
    • Data linkage across ambulance services and acute trusts: assessing the potential for improving patient care

      Clark, Sophie; Porter, Alison; Halter, Mary; Damiani, Mike; Dorning, Holly; McTigue, Martin (2016-09)
      Background Currently, most callers to 999 ambulance services are transported to the hospital emergency department (ED). However, ambulance services receive no further information on those patients, and commissioners do not have the full picture of patient care. The London Ambulance Service have worked with one acute trust to establish the feasibility of data linkage, but questions remain about transferability of the model, and how learning from linked data can bring about changes in patient care and outcomes. Methods PHED Data is our two-year mixed-methods observational study which began in May 2015. We aim to establish the potential for routinely linking data from acute trusts and ambulance services, to allow diagnosis, health care intervention, and mortality outcomes to be tracked, with a range of potential benefits for patient care within ambulance services and across the healthcare economy. We will work with six acute trusts from across London, selected to give a range of performance. The study has six work packages: WP1 examines the technical aspects of the linkage process; WP2-5 each analyse the data to develop one themed indicator set, with qualitative work examining their perceived relevance and viability; WP6 examines how the indicator sets might influence commissioning decisions and service improvements. Results So far, we have engaged with six selected acute trusts; all have shown strong interest in collaborating. We are currently arranging the logistical aspects of data sharing. We aim to respond to trusts' particular interests in our analyses, in addition to developing our common indicator set. Conclusions The proposed work has the potential to bring about quality improvements to current systems and support the development of new pathways and protocols for pre-hospital interventions. Benefits will be felt across the healthcare system. Our findings will be relevant to health service providers across the UK, who all face similar challenges in pre-hospital care. https://emj.bmj.com/content/emermed/33/9/e12.2.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-2016-206139.39
    • Data linkage across ambulance services and acute trusts: challenges and opportunities

      Clark, Sophie; Porter, Alison; Halter, Mary; Dorning, Holly (2017-10)
      Background Most callers to 999 ambulance services are transported to hospital emergency departments (EDs), but ambulance services receive no information on patient outcomes. PHED Data is a two-year mixed-methods observational study of the process and potential benefits of linking data from EDs with ambulance service data to allow analysis of patient outcomes. We report on our first aim, to examine the potential opportunities and challenges to routinely linking these data. Methods We approached six acute trusts, selected to give a range of performance, location and size, from an English metropolitan area. We used a structured learning log to collect data on the process, time input and reflections. We analysed these data with descriptive statistics, and qualitatively for themes. Results All six trusts we approached agreed to participate. Data were linked using an algorithm based on date, time and patient demographics. We achieved a dataset of 7 75 018 records covering 2012–2016, and a linkage rate of 81%. We identified five stages of the process: senior approval; exploring data availability; information governance agreement; data transfer and linking. The most intensive phases were; negotiating senior approval (mean research team input per trust of 8 hours 5 min [SD 8 hours 3 min] plus additional time from acute trusts), and data linkage (mean research team input per trust 12 hours 40 min [SD 7 hours 4 min]). The stage which took the longest was information governance (mean 19 weeks). Key themes included the positive attitudes of trusts to participating, the range of decision-makers involved, and the need for sustained input from the research team. Conclusions We have found the process of data linkage to be feasible, but requires dedicated time from research and trust staff, over a prolonged period, in order to achieve initial set up. Linked data are now being analysed. https://emj.bmj.com/content/34/10/696.1 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/ http://dx.doi.org/10.1136/emermed-2017-207114.3
    • Development and pilot of clinical performance indicators for English ambulance services

      Siriwardena, Aloysius; Shaw, Deborah; Donohoe, Rachel; Black, Sarah; Stephenson, John; National Ambulance Clinical Audit Steering Group (2010-04-12)
      Introduction There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008–2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidence-based interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services. https://emj.bmj.com/content/27/4/327. 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 http://dx.doi.org/10.1136/emj.2009.072397
    • Do paediatric early warning score relate to emergency department outcomes for children aged 0–2 years brought in by ambulance?

      Broughton, William (2017-10)
      Background Current ambulance service policy requires paramedics in certain parts of the UK to transport children aged 0–2 years to hospital, regardless of their presenting complaint. A number of Paediatric Early Warning Scores (PEWS) exist to detect deterioration in the hospitalised child. This study aims to evaluate and understand the potential utility of PEWS in an ambulance service setting. Method This study is a retrospective analysis of patient reports over a 12 month period (June 2013–June 2014). PEWS are calculated using ambulance vital signs and compared against the following ED discharge outcomes: admission to hospital, GP referral and discharge home. Data analysis consisted of the variables of sensitivity; specificity; positive and negative predictive values; positive and negative likelihood ratios; and ROC curve for the PEWS values against the three main outcomes. Results From a randomised sample of 300 patient records, 131 were excluded based on the exclusion criteria listed above, leaving 169 complete data sets that were included for analysis. Of the 169 record analysed, 100 (59.2%) were discharged to home, 30 (17.8%) referred to their GP, and 18 (10.7%) were admitted following assessment in the ED. PEWS for admission showed low sensitivity (6.8%–10.12%). PEWS for GP referral also demonstrated low sensitivity (15.53%–18.12%). PEWS for discharge to home showed higher sensitivity and specificity than other outcomes. Discussion Overall, PEWS has some degree of high specificity in all outcome measures, but often with wide confidence intervals. PEWS is weakly sensitive across all outcomes, and this is demonstrated in the AUCs for each outcome measure. As a potential diagnostic test to predict ED outcome, in this study PEWS is shown to perform poorly. Further work is therefore required to determine the utility of PEWS, or other early warning scores, for use in an out-of-hospital setting. https://emj.bmj.com/content/34/10/e3.2 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/emermed-2017-207114.11
    • Ecstasy toxicity and the cooling factor

      Archer, Tom (2008-07-25)
      A rapid response unit (RRU) and ambulance were dispatched to a young adult reported to be fitting at the site of a “rave”. On arrival, the patient was being treated by a medical team who were providing cover at the event and the RRU paramedic. The patient was reported to have taken eight ecstasy tablets and had been fitting for approximately 10 min, but this had been terminated with 10 mg diazepam (Diazemuls) given intravenously. He had also been given 800 μg naloxone and 50 ml 0.9% normal saline had also been administered. https://emj.bmj.com/content/25/8/534 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/emj.2007.054783
    • Emergency care practitioners: impact of the new role

      Halter, Mary; Marlow, T.; Jackson, D. (2006-04)
      The emergency care practitioners (ECP) role is one requiring a new model of education: the Department of Health promoting a 16 week course. In London, ECPs undertake a two year interdisciplinary healthcare diploma, practising after completion of modules in “the nature of physical assessment” and “clinical decision making”, then covering pharmacology, paediatrics, minor illness, minor injury, chronic conditions, and mental health. Clinical placements and self management are central. https://emj.bmj.com/content/23/4/e31 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/ http://dx.doi.org/10.1136/emj.2005.032946
    • 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