• 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
    • Effect of a centralised transfer service on characteristics of inter-hospital neonatal transfers

      Kempley, S. T.; Baki, Y.; Hayter, G.; Ratnavel, Nandiran; Cavazzoni, E.; Reyes, T. (2007-05)
      To determine the effect of a centralised neonatal transfer service on numbers of neonatal transfers and the time taken for teams to reach the baby. https://fn.bmj.com/content/92/3/F185 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/adc.2006.106047
    • The effect of a heart failure training intervention assessed via clinical simulation

      Edwards, Timothy (2011-08)
      Abstract published with permission. Prehospital differential diagnosis of heart failure (HF) by paramedics is sometimes unreliable (Schaider et al, 1995) and may lead to therapeutic interventions being withheld (Jenkinson et al, 2008) or the initiation of inappropriate and potentially harmful treatment (Wuerz and Meador, 1992). To date, no studies have evaluated the effect of participation in a HF training intervention on diagnostic accuracy among undergraduate UK paramedics assessed through clinical simulation. In this study, 17 paramedics were exposed to three mannequin based scenarios designed to simulate HF, pneumonia and chronic obstructive pulmonary disease (COPD). Participants were given up to 10 minutes to examine each mannequin and scrutinize clinical data before recording a diagnosis. Participant demographics and self reported confidence relating to assessment and management of HF were collected via a questionnaire. Two weeks later, participants attended a 90 minute targeted HF training intervention. Two weeks post training, the paramedics repeated the clinical simulation exercise and questionnaire. Initial diagnostic sensitivity and specificity for HF were higher than that reported in a previous UK clinical study, and improved following participation in a training intervention, although this failed to reach significance (83% vs 100% and 91.67 vs 100%, P>0.05). A significant improvement in self reported confidence relating to use of ECG findings in assessment of HF patients was noted (z=-2.309, P=0.021). In this study, paramedic differential diagnosis of HF assessed through clinical simulation demonstrated a non-significant trend towards improved sensitivity and specificity following participation in a targeted training intervention.
    • The effect of airway management on CPR quality in the PARAMEDIC2 randomised controlled trial

      Deakin, Charles; Nolan, Jerry P.; Ji, Chen; Fothergill, Rachael; Quinn, Tom; Rosser, Andy; Lall, Ranjit; Perkins`, Gavin (2020-11-12)
    • 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 T.; Gunson, Imogen; Pocock, Helen; Rees, Nigel; et al. (2019-07)
    • Emergency care of older people who fall: a missed opportunity

      Snooks, Helen A.; Halter, Mary; Close, Jacqueline; Cheung, Wai Yee; Moore, Fionna; Roberts, Stephen E. (2006-12-01)
      A high number of emergency (999) calls are made for older people who fall, with many patients not subsequently conveyed to hospital. Ambulance crews do not generally have protocols or training to leave people at home, and systems for referral are rare. The quality and safety of current practice is explored in this study, in which for the first time, the short-term outcomes of older people left at home by emergency ambulance crews after a fall are described. Results will inform the development of care for this population. https://qualitysafety.bmj.com/content/15/6/390 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 10.1136/qshc.2006.018697
    • 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
    • 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 T.; et al. (2017-01)
    • Experience of a novel community testing programme for COVID-19 in London: Lessons learnt

      Wallis, Gabriel; Suracusa, Francesca; Blank, Michael; Painter, Helen; Sanchez, Javier; Salinas, Kelcy; Mamuyac, Cherifer; Marudamuthu, Cindy; Wrigley, Fenella; Corrah, Tumena; et al. (2020-09)
    • 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)
    • 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.
    • Framework for assessment of the 12 lead ECG in transient loss of consciousness

      Edwards, Timothy (2012-11)
      Abstract published with permission. Following the introduction of pre-hospital thrombolysis, the acquisition and interpretation of the 12 lead ECG has become a routine part of UK paramedic practice. Although there is a growing body of evidence that confirms the diagnostic ability of paramedics in this area, little is known regarding the ability of paramedics to scrutinise the 12 lead ECG for other abnormalities. Recent publication of NICE guidance (NICE, 2010) relating to transient loss of consciousness (T-LOC) requires practitioners responsible for assessment of the 12 lead ECG post T-LOC to be competent in identifying a range of abnormalities. This paper describes a novel assessment framework in the form of a mnemonic designed to assist paramedic students in scrutinising the ECG for abnormalities post T-LOC. The need for further research to validate this assessment framework in educational and clinical settings is emphasised.
    • 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 T. (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
    • The future of paramedic intubation: who should be responsible?

      Hodkinson, Mark (2010-08)
      Prehospital airway management in trauma patients has been the subject of debate among many professionals for a number of years. At present, the gold standard for airway management and optimal ventilation is endotracheal intubation. Paramedics, as the frontline prehospital care providers, are currently able to practice endotracheal intubation in order to secure an airway, but only when the patient is comatose with no gag reflex. Training in endotracheal intubation has been under close scrutiny by regulatory bodies such as the Joint Royal Colleges Ambulance Service Liaison Committee, with emphasis on using other techniques to secure the airway, including supra-glottic airway devices. Rapid sequence induction and drug assisted airway management is only carried out by doctors working in the prehospital arena. However, a number of studies document that paramedics are more than capable of carrying out successful rapid sequence induction in trauma patients. This article considers the training received by paramedics in airway management, techniques that are employed and the influence of current literature on the debate over paramedic endotracheal intubation. Abstract published with permission.
    • Genuine illness and injury during Europe’s largest emergency service major incident exercise

      Cannon, E.; Edwards, Timothy; Fothergill, Rachael T. (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
    • High incidence of acute coronary occlusion in patients without protocol positive ST segment elevation referred to an open access primary angioplasty programme

      Apps, Andrew; Malhotra, Aseem; Tarkin, Jason; Smith, Robert; Kabir, Tito; Lane, Rebecca; Mason, Mark; Ali, Omar; Rogers, Paula; Banya, Winston; et al. (2013-07)
      BACKGROUND: Primary percutaneous coronary intervention (PPCI) programmes vary in admission criteria from open referral to acceptance of electrocardiogram (ECG) protocol positive patients only. Rigid criteria may result in some patients with acutely occluded coronary arteries not receiving timely reperfusion therapy. OBJECTIVE: To compare the prevalence of acute coronary occlusion and, in these cases, single time point biomarker estimates of myocardial infarct size between patients presenting with protocol positive ECG changes and those presenting with less diagnostic changes in the primary angioplasty cohort of an open access PPCI programme. METHODS: We retrospectively performed a single centre cross sectional analysis of consecutive patients receiving PPCI between January and August 2008. Cases were categorised according to presenting ECG-group A: protocol positive (ST segment elevation/left bundle branch block/posterior ST elevation myocardial infarction), group B: ST segment depression or T-wave inversion, or group C: minor ECG changes. Clinical characteristics, coronary flow grades and 12 h postprocedure troponin-I levels were reviewed. RESULTS: During the study period there were 513 activations of the PPCI service, of which 390 underwent immediate angiography and 308 underwent PPCI. Of those undergoing PPCI, 221 (72%) were in group A, 41 (13%) in group B and 46 (15%) in group C. Prevalence of coronary occlusion was 75% in group A compared with 73% in group B and 63% in group C. Median 12 h postintervention troponin-I (25th-75th percentile) for those with coronary occlusion was significantly higher in group A patients; 28.9 μg/l (13.2-58.5) versus 18.1 μg/l (6.7-32.4) for group B (p=0.03); and 15.5 μg/l (3.8-22.0) for group C (p<0.001), suggesting greater infarct size in group A. CONCLUSIONS: A number of patients referred to an open access PPCI programme have protocol negative ECGs but myocardial infarction and acute coronary artery occlusion amenable to angioplasty. https://pmj.bmj.com/content/postgradmedj/89/1053/376.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/postgradmedj-2012-130818
    • High-risk non-ST elevation acute coronary syndromes (NSTEACS) for paramedics

      Reed, Ashley (2012-08)
      Abstract published with permission. Pre-hospital clinicians frequently encounter patients suffering acute coronary syndromes (ACS) and they form an integral part in recognising and conveying the ST-elevation myocardial infraction (STEMI) patient to the most appropriate destination, namely the heart attack centre (HAC). The emphasis has been upon the recognition and subsequent management of the STEMI patient. The non-ST elevation acute coronary syndrome (NSTEACS) patient has a similar mortality and morbidity yet does not receive the same pathways as STEMI. This article aims to provide an understanding based on a case study around NSTEACS with supporting evidence relating to risk stratification, clinical trials and clinical guidelines of what needs to be developed to enhance the care we provide to the NSTEAC patient in the pre-hospital arena.