• Reflecting on events

      Lawrence, Pat (2008-02)
    • Relationship with between adrenaline dose and survival from out of hospital cardiac arrest

      Fothergill, Rachael; Perkins, Gavin D.; Deakin, Charles D.; Moore, Fionna (2014-05)
    • Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

      Fothergill, Rachael; Emmerson, Amber C.; Iyer, Rajeshwari; Lazarus, Johanna; Whitbread, Mark; Nolan, Jerry P.; Deakin, Charles D.; Perkins, Gavin D. (2019-05)
    • Respiratory protection during simulated emergency pediatric life support: a randomized, controlled, crossover study

      Schumacher, Jan; Gray, Stuart A.; Michel, Sophie; Alcock, Roger; Brinker, Andrea (2013-02)
    • Response to letter regarding article, "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.; et al. (2014-06)
    • Right ventricular infarction in the pre-hospital setting: A hidden complication

      Taylor, Samantha (2012-12-28)
      Abstract published with permission. Right ventricular infarction (RVI) can occur in isolation but is more commonly associated with inferior myocardial infarction (IMI). It has a higher mortality rate compared to isolated left ventricular infarction and often presents with complications. Early recognition of RVI in paramedic practice is key to decreasing patient mortality. This article focuses on RVI within the pre-hospital environment. Particular emphasis is placed on right precordial electrocardiogram (ECG) lead placement, judicious administration of intravenous fluids in the hypotensive patient, and specific complications associated with vasodilatory drugs in RVI.
    • Risk Prediction Models for Out-of-Hospital Cardiac Arrest Outcomes in England

      Ji, Chen; Brown, Terry P.; Booth, Scott J.; Hawkes, Claire A.; Nolan, Jerry P.; Mapstone, James; Fothergill, Rachael; Spaight, Robert; Black, Sarah; Perkins, Gavin D. (2020-03-10)
    • 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, Sotiris; 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; Williams, Julia; Gompertz, Patrick (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