• 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; 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; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2017-09)
    • Time-trend analyses of bleeding and mortality after primary percutaneous coronary intervention during out of working hours versus in-working hours: an observational study of 11 466 patients.

      Iqbal, M. Bilal; Khamis, Ramzi; Ilsley, Charles; Mikhail, Ghada; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Archbold, Andrew; Lim, Pitt; et al. (2015-06)
    • The timeline of information exchange: a service evaluation of London Ambulance Service NHS Trust’s front line communication and emergency response to Exercise Unified Response

      Nunan, Jordan; Palfreyman-Jones, Samantha; Milne, Rebecca; Wakefield, Alison (2020-03-01)
      Abstract published with permission. Introduction: Exercise Unified Response, Europe’s largest major incident training exercise to date, provided a rich environment for the emergency services to test their multi-agency crisis response capabilities. Supported by the London Ambulance Service NHS Trust, this service evaluation examined London Ambulance Service NHS Trust front line communication and decision-making via body-worn camera footage. Methods: Twenty London Ambulance Service NHS Trust front line responders and evaluators were each equipped with a body-worn camera during Exercise Unified Response. The service evaluation aimed to: (a) produce timelines of the London Ambulance Service NHS Trust’s response in order to identify key events and actions during the ‘golden hour’ (the crucial first hour in the care of trauma patients), the proceedings of command meetings and the multi-agency response; and (b) develop recommendations for future training and evaluations. Results: The service evaluation identified that, within the golden hour, London Ambulance Service NHS Trust first responders rightly and rapidly declared the event a major incident, requested resources and assigned roles. Triage crews were tasked quickly, though it was identified that their efficiency may be further enhanced through more detailed triage briefings prior to entering the scene. The command meetings (led by the Metropolitan Police) lacked efficiency, and all agencies could make more effective use of the multi-agency shared radio network to address ongoing matters. Finally, London Fire Brigade and London Ambulance Service NHS Trust teams demonstrated clear communication and co-ordination towards casualty extraction. Conclusion: Successful multi-agency working requires clear communication, information sharing and timely command meetings. It is recommended that Joint Emergency Services Interoperability Principles multi-agency talk groups should be utilised more frequently and used to complete a joint METHANE report. In addition, training in areas such as communication skills and detailed briefings will enhance the front line response. Finally, body-worn cameras are shown to be an effective service evaluation tool, as a basis for promoting best practice as well as highlighting areas for future training and evaluations.
    • Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literature

      Robinson, Simon; Kirton, Jordan (2020-12-01)
      Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. Abstract published with permission.
    • Transportation of patients with specialist palliative care needs by a local ambulance provider-policy shaping

      Swann, d.; Whitmore, David; Suggs, L.; Edmonds, P.; Waight, C.; Jones, E.; Crook, T.; Rudgyard, K. (2006-03)
    • Treating the unexpected: the opiate overdose patient

      Willis, Sam (2010-12)
      Ambulance practitioners are regularly faced with those who present with a form of drug overdose. The subject of substance misuse can be controversial, delicate and are not always straightforward to manage. Not only can substance misuse be a sensitive topic to approach, but patients can be adept at hiding the signs and symptoms from friends, family and ambulance practitioners (Caroline 2008). In addition, it may be difficult to establish what exactly has been taken, when, and how much. Gaining consent to treat the patient can also be fraught with difficulties. This reflective account uses a case from practice which highlights several of the difficulties that ambulance practitioners face when dealing with this type of patient. Abstract published with permission.
    • True posterior myocardial infarction: the importance of leads V7–V9

      Lindridge, Jaqualine (2009-05-22)
      An ambulance crew attended a patient complaining of chest pain with a clinical picture strongly suggestive of acute myocardial infarction (AMI). A 12-lead electrocardiogram (ECG) was obtained, which demonstrated ST segment depression of 1 mm in V2–V4 with upright T waves and hyperacute R waves in V1 and V2 (fig 1). A posterior myocardial infarction (MI) was considered and a series of posterior views was obtained to confirm the diagnosis. Leads V7 and V8 revealed ST segment elevation of 1 mm prompting removal to the cardiac catheter laboratory for expert assessment. Angiography later revealed a proximally occluded left circumflex as the infarct-related artery; which was successfully stented along with an incidentally critical mid-left anterior descending artery. https://emj.bmj.com/content/26/6/456. 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.2008.069195
    • Twenty-five years of London's Air Ambulance paramedics

      Edwards, Timothy; Chalk, Graham (2014-05)
    • 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