• Safety and efficacy of paramedic treatment of regular supraventricular tachycardia

      Whitbread, Mark; Baker, Victoria; Richmond, Laura; Kirkby, Claire; Robinson, Gemma; Antoniou, Sotiris; Schilling, Richard (2013-04)
    • Safety and efficacy of paramedic treatment of regular supraventricular tachycardia: a randomised controlled trial

      Honarbakhsh, S.; Baker, V.; Kirkby, C.; Patel, K.; Robinson, G.; Antoniou, S.; Richmond, L.; Ullah, W.; Hunter, R.J.; Finlay, M.; et al. (2017-09)
      Introduction Supraventricular tachycardias (SVTs) are a common cause of acute hospital presentations. Adenosine is an effective treatment. To date, no studies have directly compared paramedic-with hospital-delivered treatment of acute SVT with adenosine. Method Randomised controlled trial comparing the treatment of SVT and discharge by paramedics with conventional emergency department (ED)-based care. Patients were excluded if they had structural heart disease or contraindication to adenosine. Discharge time, follow-up management, costs and patient satisfaction were compared. Results Eighty-six patients were enrolled: 44 were randomised to paramedic-delivered adenosine (PARA) and 42 to conventional care (ED). Of the 37 patients in the PARA group given adenosine, the tachycardia was successfully terminated in 81%. There was a 98% correlation between the paramedics’ ECG diagnosis and that of two electrophysiologists. No patients had any documented adverse events in either group. The discharge time was lower in the PARA group than in the ED group (125 min (range 55–9513) vs 222 min (range 72– 26 153); p=0.01), and this treatment strategy was more cost-effective (£282 vs £423; p=0.01). The majority of patients preferred this management approach. Being treated and discharged by paramedics did not result in the patients being less likely to receive ongoing management of their arrhythmia and cardiology follow-up. Conclusions Patients with SVT can effectively and safely be treated with adenosine delivered by trained paramedics. Implementation of paramedic-delivered acute SVT care has the potential to reduce healthcare costs without compromising patient care. https://heart.bmj.com/content/heartjnl/103/18/1413.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-2016-309968
    • ‘Shining a light on the gaps for learning’

      Banerjee, Anita; Mansfield, Amanda (2020-10)
    • Should emergency medical technicians be considered for the role of the emergency care practitioner?

      Halter, Mary; Marlow, T.; Jackson, D.; Moore, Fionna; Postance, B. (2006-11)
      We enjoyed a recent discussion in this journal about the evaluation of the role of the emergency care practitioner (ECP).1,2 In the UK, 77% of ECPs are paramedics and most of the remainder are nurses,2 although studies report them as a homogeneous group. We also find differences within ECPs interesting, particularly as ECPs in London have also been recruited from emergency medical technicians (EMTs). https://emj.bmj.com/content/23/11/888.1 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. http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emj.2006.038968
    • Should the Kendrick Extrication Device have a place in pre-hospital care?

      Brown, Nick (2015-06)
      Abstract published with permission. The Kendrick Extrication Device (KED) is described as an ‘emergency patient handling device designed to aid in the immobilisation and short transfer movement of patients with suspected spinal/cervical injuries’ (Ferno-Washington, 2001).The device that evolved in the late 1970s was originally intended to assist with the immobilisation and extrication of racing drivers from their cockpit (American Academy of Orthopaedic Surgeons et al, 2012;Trafford et al, 2014). Since then it has become adopted by many ambulance services as a tool intended to assist in the immobilisation and extrication of patients, particularly from road traffic collisions (RTC) and is a recognised piece of equipment among paramedics. However, its assimilation into the pre-hospital environment and overall appropriateness in patient care should be viewed with caution. This article comments on the potential adverse risks associated around delayed extrication, the impact on respiratory function and the potential for increased movement of the casualty. Additionally, it highlights the current lack of evidence to support its use.
    • Stroke mimics in the pre-hospital setting

      Edwards, Melanie J.; Fothergill, Rachael T.; Williams, Julia; Gompertz, P. (2015-05)
      Accurate identification of stroke patients is essential to ensure appropriate and timely treatment. Stroke mimics —patients initially suspected to have suffered a stroke who are subsequently diagnosed with a condition other than stroke —are estimated to account for 5 –33% of suspected stroke patients conveyed by paramedics to a hospital stroke unit. The prevalence of stroke mimics in London has not been investigated although pan-London hospital data suggests that one quarter of all patients admitted to hyper-acute stroke units (HASUs) are stroke mimics. Participants were recruited as part of a larger study investigating whether the use of the Recognition of Stroke in the Emergency Room (ROSIER) tool by ambulance crews improved pre-hospital stroke recognition. Only patients indicated by the ROSIER to have potentially suffered a stroke and conveyed to a participating HASU (n=256) were included. A final diagnosis of stroke was received by 160 patients (“strokes”) while 96 patients received a final diagnosis of nonstroke (“mimics”), resulting in a stroke mimic rate of 38%. Mimics received a wide range of diagnoses, including seizure, syncope, brain tumour, non-organic stroke/symptoms, sepsis, somatisation, and migraine. Compared to strokes, mimics had a lower total ROSIER score, displayed fewer stroke-related symptoms, and presented with more symptoms not indicative of a stroke (e.g. loss of consciousness/syncope, seizure). The stroke mimic rate is higher than reported by previous studies and pan-London hospital data. It is unlikely this higher rate is due to the use of the ROSIER since the speci ficity of the ROSIER is equal to the FAST in the pre-hospital setting (Fothergill et al, submitted). Stroke recognition in the prehospital setting needs to be improved in order to reduce the number of non-strokes falsely identi fied as stroke and to ensure these patients are taken to the appropriate facility for treatment. https://emj.bmj.com/content/emermed/32/5/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-2015-204880.22
    • Student paramedics need funding too...

      Chapman, Eleanor (2019-01-12)
      In 2018, a new student column shared perspectives from first, second and third year students across UK paramedicine programmes. This year, in a special quarterly feature, we will follow Eleanor Chapman, who has now graduated, on her journey as a newly qualified paramedic. Abstract published with permission.
    • A study to determine the EZ-IO® Intraosseous Infusion System success rate, including impact on return of spontaneous circulation

      Woodhart, Ben; Shaw, Joanna (2016-09)
      Background In the UK the EZ-IO® Intraosseous Infusion System is a paramedic delivered technique involving the placement of the Intraosseous (IO) needle into the patient's bone marrow via an EZ-IO driver. The primary use for EZ-IO is when intravenous (IV) access is not possible, mainly for patients in cardiac arrest but may include severely unwell/injured patients. This study aimed to determine EZ-IO success rate, including impact on return of spontaneous circulation (ROSC). Methods One hundred and ninety-five cardiac arrest patient records where EZ-IO placement was attempted were retrospectively examined to determine whether ROSC was achieved at any point. Findings were compared to records where resuscitation was attempted and patients were administered drugs IV and tested for association using Pearson's Chi-Square Test. In addition, patients' records were assessed for their compliance to best practice guidance issued by the Joint Royal Colleges Ambulance Liaison Committee for use in UK Ambulance Services and manufacturer's guidelines. Results ROSC was achieved for 29% of the patients who had an EZ-IO inserted (n=57), therefore for 71% (n=138) ROSC was not achieved. This compares to 46% (n=338) and 54% (n=399) retrospectively for patients administered drugs IV. We observed a strong association between method of access and patient's outcome (χ2 (1)=17.465, p=.000). Where an EZ-IO was attempted 100% (n=195) were identified as having a successful IO placement, although certain areas of documentation were highlighted as requiring improvement, specifically: insertion site (recorded for 26%, n=51); needle size (74%, n=145), and saline flush (93%, n=182). Conclusions Although, this shows that the practice of pre-hospital EZ-IO insertion is successful, it compares less favourably to administering resuscitation drugs IV. However, there may be other factors associated with achieving ROSC that have not been taken into account, including the reasons IV access was not possible and whether this was an influencing factor. https://emj.bmj.com/content/emermed/33/9/e5.2.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-2016-206139.19
    • Supporting research and development in ambulance services: research for better health care in prehospital settings

      Siriwardena, Aloysius; Donohoe, Rachel; Stephenson, John; Phillips, Paul (2010-04-12)
      Background This paper discusses recent developments in research support for ambulance trusts in England and Wales and how this could be designed to lead to better implementation, collaboration in and initiation of high-quality research to support a truly evidence-based service. Method The National Ambulance Research Steering Group was set up in 2007 to establish the strategic direction for involvement of regional ambulance services in developing relevant and well-designed research for improving the quality of services to patients. Results Ambulance services have been working together and with academic partners to implement research and to participate, collaborate and lead the design of research that is relevant for patients and ambulance services. Conclusion New structures to support the strategic development of ambulance and prehospital research will help address gaps in the evidence for health interventions and service delivery in prehospital and ambulance care and ensure that ambulance services can increase their capacity and capability for high-quality research. https://emj.bmj.com/content/27/4/324. 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.2009.072363
    • A survey of emergency oxygen guideline implementation among all 15 UK Ambulance Services in early 2011

      Moore, Fionna P.; Davison, A.G.; Smith, J.; O'Driscoll, B. Ronan (2011-12)
      The British Thoracic Society (BTS), together with 21 other societies published a UK guideline for emergency oxygen use in 2008. This guideline was endorsed by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) who produced new oxygen guidance for ambulance crews in April 2009. We have conducted a survey of implementation of this guidance among UK Ambulance Services in early 2011. A questionnaire was sent to the Medical Directors of all 15 UK Ambulance Services and all, or their nominated deputies responded. Eleven of fifteen respondents reported full implementation of the 2009 JRCALC oxygen guidance throughout their service and ten of these reported that all relevant staff are trained in this area of practice. However, an informal survey of about 100 front line ambulance crews in one of these areas found that none were aware of the 2009 JRCALC document so the above figures may be aspirational and not yet achieved at operational level. Four services reported that they have completed audits of guideline implementation and a further three services are planning audits. All 15 services reported that 81%e100% of response vehicles were equipped with oximeters and the availability of oxygen masks was as follows: 15/15 reservoir masks; 12/15 simple face masks, 12/15 28% Venturi masks, 6/15 24% Venturi masks, 10/15 nasal cannulae. However, the informal survey of front-line staff from one ambulance service showed that Venturi masks were not actually available at operational level although the Regional response indicated universal availability. A separate survey found that no UK ambulance service has access to air cylinders, compressors or ultrasonic nebulisers for COPD patients so all nebulised treatment is oxygendriven. Six of 15 services reported that they had protocols to limit the duration of oxygen-driven nebuliser therapy for COPD patients. Two services have a record of all patients in their area who have an Oxygen Alert card. This survey suggests that UK Ambulance Services are taking steps to implement the BTS and JRCALC emergency oxygen guidance but it is unclear how much advice and equipment had been cascaded to front-line staff by Spring 2011. https://thorax.bmj.com/content/thoraxjnl/66/Suppl_4/A108.2.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/thoraxjnl-2011-201054c.101
    • Taking the pulse of the London maternity units

      Lingen-Stallard, Andrew; Read, Jessica; Helleur, Angela (2012-05)
    • TCT-193 Effect of drug-eluting stents versus bare-metal stents on long-term mortality following rotational atherectomy for complex calcific coronary lesions

      Iqbal, M. Bilal; Kabir, Tito; Archbold, Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; Mathur, Anthony; et al. (2013-10)
    • TCT-241 Drug-eluting stents are superior to bare metal stents in reducing mortality in cardiogenic shock complicating ST-elevation myocardial infarction

      Iqbal, M. Bilal; Hadjiloizou, Nearchos; Kabir, Tito; Archbold, Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; et al. (2013-10)
    • Temporal and geographic patterns of stab injuries in young people: a retrospective cohort study from a UK major trauma centre

      Vulliamy, Paul; Faulkner, Mark; Kirkwood, Graham; West, Anita; O'Neill, Breda; Griffiths, Martin P.; Moore, Fionna; Brohi, Karim (2018-11)
      https://bmjopen.bmj.com/content/8/10/e023114.long Objectives To describe the epidemiology of assaults resulting in stab injuries among young people. We hypothesised that there are specific patterns and risk factors for injury in different age groups. Design Eleven-year retrospective cohort study. Setting Urban major trauma centre in the UK. Participants 1824 patients under the age of 25 years presenting to hospital after a stab injury resulting from assault. Outcomes Incident timings and locations were obtained from ambulance service records and triangulated with prospectively collected demographic and injury characteristics recorded in our hospital trauma registry. We used geospatial mapping of individual incidents to investigate the relationships between demographic characteristics and incident timing and location. Results The majority of stabbings occurred in males from deprived communities, with a sharp increase in incidence between the ages of 14 and 18 years. With increasing age, injuries occurred progressively later in the day (r2 =0.66, p<0.01) and were less frequent within 5 km of home (r2 =0.59, p<0.01). Among children (age <16), a significant peak in injuries occurred between 16:00 and 18:00 hours, accounting for 22% (38/172) of injuries in this group compared with 11% (182/1652) of injuries in young adults. In children, stabbings occurred earlier on school days (hours from 08:00: 11.1 vs non-school day 13.7, p<0.01) and a greater proportion were within 5 km of home (90% vs non-school day 74%, p=0.02). Mapping individual incidents demonstrated that the spike in frequency in the late afternoon and early evening was attributable to incidents occurring on school days and close to home. Conclusions Age, gender and deprivation status are potent influences on the risk of violent injury in young people. Stab injuries occur in characteristic temporal and geographical patterns according to age group, with the immediate after-school period associated with a spike in incident frequency in children. This represents an opportunity for targeted prevention strategies in this population. https://bmjopen.bmj.com/content/bmjopen/8/10/e023114.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/bmjopen-2018-023114
    • Temporal changes in bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Hawkes, Claire A.; Booth, Scott J.; Fothergill, Rachael T.; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2017-09)