• Joining up the dots

      Laverty, Diane (2018-09)
    • Joint response unit: improving patient care and safety through collaborative working between ambulance and police services

      Zipfel, Rebecca; McIlwaine, Scott (2016-09)
      Background The London Ambulance Service NHS Trust receives more than one million calls every year, with roughly 10% of these coming from the Metropolitan Police Service. The majority of calls from the police are for patients with non-life-threatening symptoms, to which a clinical response is aimed to be dispatched within 30 minutes. When demand is high, however, ambulances get re-directed to more severely ill patients and police officers end up waiting on-scene for prolonged periods. This has a detrimental impact on the police services’ response to calls. Methods The Joint Response Unit is an initiative designed to address the above problem. It consists of a solo clinician providing a dedicated response to police requests within an assigned borough. Initiated in 2011, it now covers 12 London boroughs, with the hope of further expansion within and outside of London. This evaluation is assessing the necessity and clinical safety of this initiative. Findings An on-scene clinical response was required for 95% of patients, highlighting the need for the Joint Response Unit. Arrival time to life-threatening calls is improved and conveyance to hospital decreased due to the clinician’s ability to appropriately assess, treat and discharge on-scene. Since its implementation in 2012, the Joint Response Unit has reduced police on-scene waiting times from an average of 36 minutes to 7 minutes. Over the course of just one weekend, the faster clinical response equates to a total of 13 hours of officer-time saved. Conclusions The Joint Response Unit is a unique and successful model of collaborative working between emergency services, with benefits to both the ambulance and police services. Other services should look at replicating this model to enable effective collaboration nationally. https://emj.bmj.com/content/emermed/33/9/e3.1.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-2016-206139.11
    • Level of consciousness on admission to a Heart Attack Centre is a predictor of survival from out-of-hospital cardiac arrest

      Deakin, Charles D.; Fothergill, Rachael T.; Moore, Fionna; Watson, Lynne; Whitbread, Mark (2014-07)
    • Level of sepsis knowledge in UK Ambulance Services

      Murphy-Jones, Barry; Shaw, Joanna (2016-09)
      Background Sepsis is responsible for over 37,000 deaths a year in the UK, with long term morbidity consequences for survivors. More than 40% of cases develop within the community, making the ambulance service vitally important. This project sought to ascertain the current level of sepsis knowledge in UK ambulance services to better understand potential knowledge gaps. Methods This observational study used an online questionnaire to describe the level of knowledge of sepsis and how it is recognised and managed in the pre-hospital setting. A convenience sample of clinicians at one ambulance service was invited to complete a questionnaire which consisted of ten questions and was hosted on the web-based tool SurveyMonkey®. One hundred and seventy-one complete responses were received from ambulance staff (response rate 5.4%) and data were entered into Microsoft Excel and analysed using descriptive statistics. Results The questionnaire identified 59% of respondents (n=100) had heard of the terms sepsis and systemic inflammatory response syndrome, with 23% (n=40) identifying all three stages of sepsis. Sixty-nine per cent of respondents (n=118) identified the correct definition of sepsis, and 23% (n=39) believed this definition was used in the pre-hospital setting. Four per cent of respondents (n=7) identified all of the common signs and symptoms and 22% (n=37) knew all of the pre-hospital interventions for severe sepsis and septic shock. Finally, 71% (n=121) agreed paramedics could identify patients at high risk of sepsis, with 94% (n=161) agreeing pre-hospital recognition and interventions may improve outcomes for sepsis. Conclusions Findings showed poor knowledge of sepsis, its recognition and pre-hospital management which is supported by other literature. As a result, a mandatory training programme has been delivered and a sepsis screening tool, including prompts for appropriate management, has been produced. A continuous clinical audit will also be introduced to understand how this knowledge is applied in practice. https://emj.bmj.com/content/emermed/33/9/e10.3.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-2016-206139.34
    • 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 D.; 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
    • Managing paediatric patients with pyrexia

      Wragg, Emily; Francis, Joseph; Amblum, Jeshni (2014-12)
    • Manual thrombectomy with platelet glycoprotein IIb/IIIa blockade is associated with lower mortality in patients treated with primary PCI (9266 patients from the London Heart Attack Group)

      Virdi, Gurkamal K.; Whitbread, Mark; Modi, B.N.; Jones, Daniel A.; Rathod, Krishnaraj S.; Lim, Pitt; Jain, A.J.; Akhtar, M.M.; Singh Kalra, S.; Crake, Tom; et al. (2013-05)
    • Manual thrombus aspiration is not associated with reduced mortality in patients treated with primary percutaneous coronary intervention: an observational study of 10,929 patients with St-segment elevation myocardial infarction from the London heart attack group.

      Jones, Daniel A.; Rathod, Krishnaraj S.; Gallagher, Sean; Jain, Ajay K.; Kalra, Sundeep Singh; Lim, Pitt; Crake, Tom; Ozkor, Mick; Rakhit, Roby; Knight, Charles J.; et al. (2015-04)
    • Mechanical thrombectomy use is associated with decreased mortality in patients treated with primary percutaneous coronary intervention (9935 patients from the London Heart Attack Group)

      Modi, B.N.; Jones, Daniel A.; Rathod, Krishnaraj S.; Akhtar, M.; Jain, Ajay K.; Singh Kalra, S.; Crake, Tom; Meier, Pascal; Astroulakis, Zoe; Dollery, C.; et al. (2013-05)
      Introduction During Primary Percutaneous Coronary Intervention (PPCI) post ST-Segment Myocardial Infarction (STEMI), distal embolisation of thrombus may lead to failure to re-establish normal flow in the infarct-related artery. Manual thrombus aspiration has been shown to improve coronary perfusion as assessed by time to ST-segment resolution and myocardial blush grade. Evidence supporting the benefit of thrombus aspiration on clinical outcomes, however, is limited and inconsistent. We aimed to assess the impact of manual thrombectomy on mortality in patients presenting with STEMI across all PPCI centres in London over a 5 year period from 2007 until 2012. Methods This was an observational cohort study of 9935 consecutive patients with STEMI treated with PPCI between 2007 and 2012 at eight tertiary cardiac centres across London, UK. Patient's details were recorded at the time of the procedure into the British Cardiac Intervention Society (BCIS) database. Outcome was assessed by all-cause mortality. Anonymous datasets from the eight centres were merged for analysis. The primary end-point was all-cause mortality at a median follow-up of 2.0 years (IQR range 1.1 –3.1 years). Results Of the 9935 consecutive STEMI patients presenting for PPCI, 2859 had mechanical thrombectomy. Patients who had manual thrombectomy were significantly younger (average age 60.6 vs 62.9) and were less likely to have had a previous myocardial infarction (11.9% of thrombectomy patients vs 14.7% of nonthrombectomy patients). Patients receiving manual thromectomy were found to be significantly more likely to have had PPCI via a radial approach (33.1% in thrombectomy patients vs 19.9% in nonthromectomy patients). Procedural success (defined as TIMI 3 flow at the end of procedure) was found to be significantly more likely in patients receiving manual thrombectomy (89.5% vs 86.7%) (table 1). Patients with thrombectomy use had similar unadjusted all-cause mortality rates to those without thrombectomy use (12.7% vs 16.5%, p=NS) during the 5-year follow-up period (figure 1). After multivariable adjustment thrombectomy use was associated with significantly decreased mortality rates (HR: 0.82, 95% CI 0.68 to 0.9, p=0.04). Conclusion Mechanical thrombectomy use appears to be associated with improved outcome, in the form of decreased mortality, in this large observational trial. https://heart.bmj.com/content/heartjnl/99/suppl_2/A32.2.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/heartjnl-2013-304019.46
    • Mentorship within the paramedic profession: a practice educator's perspective

      Lane, Matthew; Rouse, James; Docking, Rachael E. (2016-05)
      Abstract published with permission. Background ‐ The rapid ascension of paramedic science within higher education is creating a significant culture change within the profession. Clinicians are now accountable for both their patients as well as the learning of their students. Mentoring practices in the paramedic profession have been adopted from the findings of professions allied to healthcare, including medicine, nursing and midwifery, where mentorship is well established. The insufficiencies of this model need to be tested to account for the idiosyncrasies of the paramedic role. Methods ‐ A convenience sample of paramedic educators were identified across two ambulance services. Focus groups were conducted to obtain rich data about participants’ opinions on current mentoring practices within the paramedic profession and recommendations for how this can be improved. Results ‐ Results demonstrated the importance of learning through observation, teaching skills and personal qualities in relation to the paramedic educator role, as previously identified in the literature produced by professions allied to healthcare. Paramedic educators also identified current challenges to practice that included organisational issues such as ‘support’, ‘recognition’ and the ‘mental well-being’ of students. Conclusions ‐ This is the first primary research to explore mentoring from the paramedic educator perspective. In order to undertake their role more effectively paramedic educators are looking for a greater investment into the culture of mentoring by ambulance services and universities to address the identified organisational issues.
    • Methodology and consent issues in emergency medicine: the ARREST trial in out-of-hospital cardiac arrest

      Perkins, Alexander; Patterson, Tiffany; Evans, Richard; Clayton, Tim; Fothergill, Rachael; Whitbread, Mark; Redwood, Simon R. (2019-10-22)
    • Mobile phones, in combination with a computer locator system, improve the response times of emergency medical services in central London

      Gossage, J.A.; Frith, D.P.; Carrell, T.W.G.; Damiani, Mike; Terris, J.; Burnand, K.G. (2008-03)
    • National initiatives to improve outcomes from out-of-hospital cardiac arrest in England

      Perkins, Gavin D.; Lockey, Andrew S.; de Belder, Mark A.; Moore, Fionna; Weissberg, Peter; Gray, Huon; Community Resuscitation Group (2016-07)
    • Older fallers: the risk and opportunity of ambulance non conveyance

      Halter, Mary; Snooks, Helen; Close, Jacqueline; Cheung, Wai Yee; Moore, Fionna (2006-04)
      Large numbers of older people fall every year. Interdisciplinary intervention can reduce the risk of falling, and the use of integrated falls services for ambulance attended patients has been promoted. Non conveyance of fallers by ambulance staff is high but the triage system is informal. This study tested whether the introduction of an assessment tool would enable emergency ambulance staff to leave older fallers at home safely. 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
    • Out-of-hospital cardiac arrest - optimal management

      Frohlich, Georg M.; Lyon, Richard; Sasson, Comilla; Crake, Tom; Whitbread, Mark; Indermuehle, Andreas; Timmis, Adam; Meier, Pascal (2013-11)