• Ultrasound: a potential new approach for cardiac arrest management

      Walker, Eoin (2017-03)
      Abstract published with permission. Introduction: Out-of-Hospital Cardiac Arrest (OHCA) is a common occurrence within the pre- hospital environment (approximately 10,000 OHCA in London - over one third of England’s national total of 28000; BHF 2015). The management can be associated with difficult decision-making. Ultrasound (US) has recently been introduced to critical care practice, yet evidence is poor around this topic in relation to OHCA. Search strategy: All cardiac arrest empirical literature within the last 15 years on US both in-hospital and pre-hospital. Discussion: Sensitivity analyses within OHCA in comparison with current practice show US is more accurate in predicting mortality than it is in predicting survivability to hospital admission or discharge. US is therefore well placed as a tool for cardiac arrest management alongside End Tidal Carbon Dioxide (ETCO2) monitoring and Electrocardiogram (ECG) findings, as none have the benefit of being a linear marker of survival. Conclusion: Recommendations show that US should form part of critical care management in OHCA as a sensitive real time marker of kinetic ventricular activity. This is alongside other markers of cardiac output, all of which carry variable levels of sensitivity (ECG, ETCO2) to best inform the advanced paramedic practitioner.
    • The unanticipated cost of the London congestion charge.

      Hartley-Sharp, Christopher; Munro, M. (2006-12)
      When the London congestion charge was introduced in 2003, operational ambulance personnel were among a group of ‘‘key workers’’ who were refused an exemption. With the charge at £8 per day and public transport options that do not meet the needs of shift workers, many staff have sought alternatives such as motorcycling, which carries an increased risk of involvement in a road traffic collision (RTC) and a greater risk of injury when this happens. https://emj.bmj.com/content/23/12/e68 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.2006.041574
    • Urinary tract infection: diagnosis and management for nurses

      Naish, Wendy; Hallam, Matt (2007-02-14)
      Urinary tract infection (UTI) is a common health problem, so it is important that nurses in all care settings know how to manage patients with this condition effectively. This article defines UTI, identifying patients who are most at risk and the underlying reasons why. Accurate diagnosis is important in the provision of treatment and the prevention of further complications, some of which can have serious consequences for patients. Inappropriate investigations are expensive, and may result in patients being over-treated. UTI is multifaceted, which makes its management difficult. However, a good understanding of prevention, assessment and management can help nurses to ensure the right treatment is offered. https://search.proquest.com/docview/219852637/abstract/858663895F434BA4PQ/1?accountid=48113. 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
    • The use of trained volunteers in the response to out-of-hospital cardiac arrest - the GoodSAM experience

      Smith, Christopher M.; Wilson, Mark H.; Wilson, Mark H.; Ghorbangholi, Ali; Hartley-Sharpe, Christopher; Gwinnutt, Carl; Dicker, Bridget; Perkins, Gavin D. (2017-12)
    • Using deterministic record linkage to link ambulance and emergency department data: is it possible without patient identifiers?

      Clark, Sophie Jane; Halter, Mary; Porter, Alison; Smith, Holly Christina; Brand, Martin; Fothergill, Rachael; Lindridge, Jaqualine; McTigue, Martin; Snooks, Helen (2019-08)
    • Using London Ambulance Service activity as a metric for quality improvement in asthma, assessment of activity data

      Sriskandakumar, S.; Nevett, Joanne; Virdi, G.; Iles, R. (2017-05)
      Aim The Healthy London Partnership (HLP) aims to improve quality of care in the capital, with a focus on children and young people, who face some of the poorest health outcomes compared with the rest of the country. Using the distribution of paediatric asthma emergency calls to London Ambulance Service (LAS) as a metric, and the HLP Asthma toolkit, we can assess the impact of our findings. Methods We gathered data from the LAS for all asthma related calls during the period of 01/01/2015 to 01/01/2016 regarding paediatric calls, ages 0–19 years. Data was analysed with attention to the distribution of calls against time, gender and conveyance to hospital. Results In the period analysed, there were a total of 10 498 asthma calls to the LAS, where 80.53% of calls were conveyed to Emergency Departments (EDs). 2946 (28.06%) were made from the 0 to 19 years age group. In the 0 to 4 years age group, 68.52% of calls were for males, to 31.48% of females in the same age group (5.39% to 2.47% respectively of all calls). There is a greater incidence of calls from males until 15 years, later more are from females. From the total number of calls, 5829 (55.52%) were made for females, with the highest incidence in September (9.94%). Weekly analysis shows most calls are made on Monday (15.91%), the busiest times are between 10am– 12pm, and from 7 pm to midnight. The data presented is generic, not specific to the location or severity of calls, but it can facilitate whole system changes. Conclusions Age, gender and time distribution of calls to the LAS provide a useful metric to enable strategies for a London-wide system change. This can be assessed using the HLP toolkit, which has provided examples of good practise and audit strategies, accessible to all healthcare providers. The data from our research can improve asthma education to parents, teachers and carers, and highlight areas for improvement. This ensures everyone involved in asthma care can benefit from the findings of our research. https://adc.bmj.com/content/102/Suppl_1/A9.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/archdischild-2017-313087.21
    • Using patient specific protocols (PSP) to achieve appropriate oxygenation in patients at risk of oxygen toxicity; from ambulance through to inpatient stay

      Toshner, R.J.; Vaghela, A.; Nevett, Joanne; Resrick, L.J. (2018-12)
      Introduction and objectives The London Ambulance Service(LAS) uses Patient Specific Protocols(PSPs) as directives for a range of conditions. Since 20061 we have worked with LAS using PSPs to prevent oxygen(O2) toxicity during ambulance transfer in patients at risk of type 2 respiratory failure. PSPs are now ‘flagged’ on our records which may also influence hospital oxygen prescribing. The aim of this study was to evaluate PSP effectiveness in influencing appropriate O2 prescribing during both ambulance transfer and hospital stay. Methods Data from 50 patients identified as at risk of oxygen toxicity(disease severity and/or raised bicarbonate) who had PSPs initiated sequentially pre-May 2017 were reviewed for; initiation bicarbonate, ED attendances, prescription and delivery of O2 in ambulance/ED/wards, and death in the subsequent year. Results Hospital records were reviewed for 43/50 (86%) patients with PSPs. Patient characteristics are shown in table 1. In the year post-PSP 20/43 (46.5%) had ≥1 hospital attendance (overall 44 attendances); there were 2 deaths(not O2-related). LAS data were available for 34/44 (77%) attendances. 30/34 (88.2%) were appropriately oxygenated during ambulance transfer. 4/34 (11.8%) had saturations above target range; of these, 2/4 had immediate action taken. In ED 34/34 (100%) patients had documented alert of O2 sensitivity and 34/40 (85%) had appropriate oxygenation. 5/40 (12.5%) had saturations above target range and 1/40 (2.5%) saturations below range; of these, 4/6 had corrective action taken to restore saturations towards target range. 21/34 (61.8%) had specified O2 prescription in ED. On ward transfer, 34/36 (94%) had saturations in range; 1/36 (2.7%) above target range, with corrective action not taken and 1/36 (2.7%) below target, with corrective action taken. 32/34 (94.1%) had ward O2 prescriptions. Conclusions PSPs continue to be an effective mechanism for ensuring safe oxygenation during ambulance transfer of at risk patients. Patients were identified appropriately for PSP; almost half were admitted in the subsequent year. Having a PSP flagged on their records also enabled safe O2 prescription and delivery from arrival in ED through to inpatient wards. While PSPs are an agreed Londonwide Ambulance tool to prevent oxygen toxicity, their impact on patient safety appears to be far wider reaching than ambulance transfer. https://thorax.bmj.com/content/73/Suppl_4/A198.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/thorax-2018-212555.337
    • Variation in epidemiology and outcomes from cardiac arrest

      Fothergill, Rachael T.; Brace-McDonnell, Samantha J.; Perkins, Gavin D. (2014-11)
    • Ventricular fibrillation—A tale of two cities

      Freese, John P.; Jorgenson, Dawn B.; Liu, Ping-Yu; Innes, Jennifer; Matallana, Luis; Nammi, Krishnakant; Donohoe, Rachael T.; Whitbread, Mark; Silverman, Robert A.; Kaufman, B. J.; et al. (2010-12-01)
    • Video games for people with schizophrenia

      Roberts, Matthew T.; Lloyd, Jack; Valimaki, Marrita; Ho, Grace Wk.; Freemantle, Megan; Bekefi, Anna Zsofia (2021-02-04)
    • Waveform analysis-guided treatment versus a standard shock-first protocol for the treatment of out-of-hospital cardiac arrest presenting in ventricular fibrillation: results of an international randomized, controlled trial

      Freese, John P.; Jorgenson, Dawn B.; Liu, Ping-Yu; Innes, Jennifer; Matallana, Luis; Nammi, Krishnakant; Donohoe, Rachael T.; Whitbread, Mark; Silverman, Robert A.; Prezant, David J. (2013-08)
    • What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

      Snooks, Helen; Khanom, Ashrafunnesa; Cole, Robert; Edwards, Adrian; Edwards, Bethan Mair; Evans, Bridie A.; Foster, Theresa; Fothergill, Rachael; Gripper, Carol P.; Hampton, Chelsey; et al. (2019-12-28)
    • What are the highest priorities for research in emergency prehospital care?

      Snooks, Helen; Evans, Angela; Wells, Bridget; Peconi, Julie; Thomas, Marie; Woollard, Malcolm; Guly, Henry; Jenkinson, Emma; Turner, Janette; Hartley-Sharpe, Christopher (2009-07-22)
      The recent UK Department of Health publication “Taking Healthcare to the Patient: Transforming NHS Ambulance Services”1 recommended that the Department of Health should commission a programme of work to build the evidence base for the delivery of emergency and unscheduled prehospital care. As a starting point, the Department of Health commissioned the 999 EMS Research Forum to review the evidence base for the delivery of emergency prehospital care; to identify gaps in the evidence base; and to prioritise topics for future research. https://emj.bmj.com/content/26/8/549. 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.2008.065862
    • What do ambulance service personnel perceive to be the process of and issues with inter-hospital transfers?

      Rouse, James (2016-06)
      Abstract published with permission. At present, the inter-hospital transfer process has been described as suboptimal and current literature fails to describe or analyse the complete transfer process. In particular, the challenges and barriers from UK NHS ambulance services are yet to be described. To examine this further, a study has been undertaken to explore a NHS ambulance service personnel’s experiences, perceptions and issues relating to the inter-hospital transfer process. The findings have shown that ambulance personnel approach inter-hospital transfers from a business perspective, which affects the way they process and perceive transfers. There exists a consensus among staff that the inter-hospital transfer policy or procedure is not fully understood, due to a lack of clarity and mixed messages throughout the process. Staff members view the inter-hospital transfer process as a nuisance and have acknowledged it was inadequately executed. Additionally, undertaking certain inter-hospital transfers is seen as challenging paramedics’ professional identities.
    • What happened on Restart a Heart Day 2017 in England?

      Brown, Terry P.; Perkins, Gavin D.; Lockey, Andrew S.; Soar, Jasmeet; Askew, Sara; Mersom, Frank; Fothergill, Rachael T.; Cox, Emma; Black, Sarah; Lumley-Holmes, Jenny (2018-09)
    • What motivates students to pursue a career in paramedicine?

      Ross, Linda; Hannah, Julian; Van Huizen, Pheona (2016)
    • Who receives bystander CPR in a witnessed out-of-hospital cardiac arrest in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Fothergill, Rachael T.; Black, Sarah; Pocock, Helen; Gunson, Imogen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2018-09)
    • Writing your NQP portfolio: hacks and tips

      Chapman, Eleanor (2019-04-08)
      This month, newly qualified paramedic, Eleanor Chapman, shines some light on the NQP portfolio, discussing its challenges and its value, while sharing some practical tips Abstract published with permission.