• Increases in survival from out-of-hospital cardiac arrest: a five year study

      Fothergill, Rachael; Watson, Lynne R.; Chamberlain, Douglas; Virdi, Gurkamal K.; Moore, Fionna; Whitbread, Mark (2013-08)
    • The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

      Perkins, Gavin D.; Kenna, Claire; Ji, Chen; Deakin, Charles D.; Nolan, Jerry P.; Quinn, Tom; Scomparin, Charlotte; Fothergill, Rachael; Gunson, Imogen M.; Pocock, Helen; et al. (2020-03)
    • Initial ventricular fibrillation waveform characteristics and outcomes among EMS-witnessed cardiac arrests

      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)
    • Inter-hospital transfer for primary angioplasty: delays are often due to diagnostic uncertainty rather than systems failure and universal time metrics may not be appropriate

      Tarkin, Jason; Malhotra, Aseem; Apps, Andrew; Smith, Robert; Di Mario, Carlo; Rogers, Paula; Lane, Rebecca; Kabir, Tito; Mason, Mark; Ilsley, Charles; et al. (2015-09)
    • Interpreting the signs

      Lawrence, Ricky (2007-10)
    • Intra-aortic balloon pump counterpulsation in the post-resuscitation period is associated with improved functional outcomes in patients surviving an out-of-hospital cardiac arrest: insights from a dedicated heart attack centre

      Iqbal, M. Bilal; Al-Hussaini, Abtehale; Rosser, Gareth; Rajakulasingham, Ramyah; Patel, Jayna; Elliott, Katharine; Mohan, Poornima; Phylactou, Maria; Green, Rebecca; Whitbread, Mark; et al. (2016-12)
    • An investigation into the introduction and implementation of fitness tests within UK ambulance services

      Clarke, V. (2006-04)
      Front line ambulance work can involve a significant amount of physical activity and manual handling, which is often sporadic and varied in nature. Although training in lifting and handling techniques is delivered to all staff, studies suggest that an above average level of physical fitness can further reduce the incidence of sickness and injury at work. 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
    • An investigation to determine whether evidence exists to support the introduction of paralysis agents into the prehospital environment, to assist endotracheal intubation for patients who sustain head injuries

      Dady, S. (2006-11-27)
      Head injuries are associated with 50% of all deaths due to trauma, about 5000 deaths annually. In traumatic injury, the brain is exposed to two insults: the initial trauma and the second insult during the body’s response. Prevention of this secondary cerebral insult may improve outcome. Intubation facilitated by rapid sequence induction (RSI) ensures appropriate ventilation, reducing the secondary insult by managing arterial CO2 levels. The existing literature indicates that prehospital RSI does not influence the outcome in patients with multiple trauma, yet fails to examine the effect of RSI and intubation on patient recovery from isolated head injury (IHI). 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/ DOI http://dx.doi.org/10.1136/emj.2006.041574
    • Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model.

      Koniotou, Marina; Evans, Bridie A.; Chatters, Robin; Fothergill, Rachael; Garnsworthy, Christopher; Gaze, Sarah; Halter, Mary; Mason, Suzanne; Peconi, Julie; Porter, Alison; et al. (2015-07)
    • Ipratropium bromide: a bit of a wheeze?

      Archer, Tom (2007-06)
      Administration of ipratropium bromide has become standard care in UK prehospital practice for acute severe or life-threatening asthma. This retrospective ‘‘before and after’’ USA study examined prehospital and emergency department records 6 months before and after the introduction of prehospital ipratropium. https://emj.bmj.com/content/24/6/439 ] 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.2007.048835
    • Is prehospital lactate testing useful in improving clinical assessment?

      Robinson, Simon (2019-06-08)
      Introduction: Lactate devices offer the potential for paramedics to improve patient triage and escalation of care for specific presentations. There is also scope to improve existing prehospital tools by including lactate measurement. Method: A literature search was conducted using the Medline, CINAHL, Academic Search Premier, Sciencedirect and Scopus databases. Findings: Acquiring prehospital lactate measurement in trauma settings improved triage and recognition of the need for critical care. Within a medical setting, studies offered mixed results in relating prehospital lactate measurement to diagnosis, escalating treatments and mortality. The accuracy of prehospital lactate measurements acquired varies, which could impact decision making. Conclusion: Prehospital lactate thresholds could aid decision making, although the literature is limited and evidence varies. Lactate values of ≥4 mmol/litre in medical and ≥2.5 mmol/litre in trauma patients could signify that care should be escalated to an appropriate facility, and that resuscitative measures should be initiated, particularly with sepsis, as reflected by standardised lactate values that guide treatment in hospitals. Similarly, a lactate value of <2 mmol/litre could mean de-escalating care into the community, although further research is warranted on this. Abstract published with permission.
    • 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; Moore, Fionna; Watson, Lynne R.; 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; 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