• Does obesity affect defibrillation parameters or outcomes among out-of-hospital cardiac arrest patients presenting in ventricular fibrillation?

      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)
    • Does prehospital intubation affect outcomes among cardiac arrest patients presenting in ventricular fibrillation?

      Donohoe, Rachael T.; Liu, Ping-Yu; Jorgenson, Dawn B.; Nammi, Krishnakant; Matallana, Luis; Innes, Jennifer; Whitbread, Mark; Kaufman, B. J.; Prezant, David J.; Silverman, Robert A.; et al. (2010-12-01)
    • Does triage of patients diagnosed by paramedics with ventricular tachycardia directly to arrhythmia centres improve patient care?

      Cooklin, Michael; Sporton, S.; Lovell, M.; Kanagaratnam, P.; Lowe, M.; Markides, V.; Mason, Mark; Whitbread, Mark (2014-10)
    • Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

      Fothergill, Rachael; Williams, Julia; Edwards, Melanie J.; Russell, Ian T.; Gompertz, Patrick (2013-11)
    • Ecstasy toxicity and the cooling factor

      Archer, Tom (2008-07-25)
      A rapid response unit (RRU) and ambulance were dispatched to a young adult reported to be fitting at the site of a “rave”. On arrival, the patient was being treated by a medical team who were providing cover at the event and the RRU paramedic. The patient was reported to have taken eight ecstasy tablets and had been fitting for approximately 10 min, but this had been terminated with 10 mg diazepam (Diazemuls) given intravenously. He had also been given 800 μg naloxone and 50 ml 0.9% normal saline had also been administered. https://emj.bmj.com/content/25/8/534 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.2007.054783
    • Effect of a centralised transfer service on characteristics of inter-hospital neonatal transfers

      Kempley, S. T.; Baki, Y.; Hayter, G.; Ratnavel, Nandiran; Cavazzoni, E.; Reyes, T. (2007-05)
      To determine the effect of a centralised neonatal transfer service on numbers of neonatal transfers and the time taken for teams to reach the baby. https://fn.bmj.com/content/92/3/F185 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/adc.2006.106047
    • The effect of a heart failure training intervention assessed via clinical simulation

      Edwards, Timothy (2011-08)
      Abstract published with permission. Prehospital differential diagnosis of heart failure (HF) by paramedics is sometimes unreliable (Schaider et al, 1995) and may lead to therapeutic interventions being withheld (Jenkinson et al, 2008) or the initiation of inappropriate and potentially harmful treatment (Wuerz and Meador, 1992). To date, no studies have evaluated the effect of participation in a HF training intervention on diagnostic accuracy among undergraduate UK paramedics assessed through clinical simulation. In this study, 17 paramedics were exposed to three mannequin based scenarios designed to simulate HF, pneumonia and chronic obstructive pulmonary disease (COPD). Participants were given up to 10 minutes to examine each mannequin and scrutinize clinical data before recording a diagnosis. Participant demographics and self reported confidence relating to assessment and management of HF were collected via a questionnaire. Two weeks later, participants attended a 90 minute targeted HF training intervention. Two weeks post training, the paramedics repeated the clinical simulation exercise and questionnaire. Initial diagnostic sensitivity and specificity for HF were higher than that reported in a previous UK clinical study, and improved following participation in a training intervention, although this failed to reach significance (83% vs 100% and 91.67 vs 100%, P>0.05). A significant improvement in self reported confidence relating to use of ECG findings in assessment of HF patients was noted (z=-2.309, P=0.021). In this study, paramedic differential diagnosis of HF assessed through clinical simulation demonstrated a non-significant trend towards improved sensitivity and specificity following participation in a targeted training intervention.
    • The effect of airway management on CPR quality in the PARAMEDIC2 randomised controlled trial

      Deakin, Charles; Nolan, Jerry P.; Ji, Chen; Fothergill, Rachael; Quinn, Tom; Rosser, Andy; Lall, Ranjit; Perkins`, Gavin (2020-11-12)
    • The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials

      Perkins, Gavin D.; Kenna, Claire; Ji, Chen; Deakin, Charles D.; Nolan, Jerry P.; Quinn, Tom; Fothergill, Rachael; Gunson, Imogen; Pocock, Helen; Rees, Nigel; et al. (2019-07)
    • Emergency care of older people who fall: a missed opportunity

      Snooks, Helen; Halter, Mary; Close, Jacqueline; Cheung, Wai Yee; Moore, Fionna; Roberts, Stephen E. (2006-12-01)
      A high number of emergency (999) calls are made for older people who fall, with many patients not subsequently conveyed to hospital. Ambulance crews do not generally have protocols or training to leave people at home, and systems for referral are rare. The quality and safety of current practice is explored in this study, in which for the first time, the short-term outcomes of older people left at home by emergency ambulance crews after a fall are described. Results will inform the development of care for this population. https://qualitysafety.bmj.com/content/15/6/390 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 10.1136/qshc.2006.018697
    • Emergency care practitioners: impact of the new role

      Halter, Mary; Marlow, T.; Jackson, D. (2006-04)
      The emergency care practitioners (ECP) role is one requiring a new model of education: the Department of Health promoting a 16 week course. In London, ECPs undertake a two year interdisciplinary healthcare diploma, practising after completion of modules in “the nature of physical assessment” and “clinical decision making”, then covering pharmacology, paediatrics, minor illness, minor injury, chronic conditions, and mental health. Clinical placements and self management are central. 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
    • Epidemiology and outcomes from out-of-hospital cardiac arrests in England

      Hawkes, Claire A.; Booth, Scott; Ji, Chen; Brace-McDonnell, Samantha J.; Whittington, Andrew; Mapstone, James; Cooke, Matthew W.; Deakin, Charles D.; Gale, Chris P.; Fothergill, Rachael; et al. (2017-01)
    • Experience of a novel community testing programme for COVID-19 in London: Lessons learnt

      Wallis, Gabriel; Siracusa, Francesca; Blank, Michael; Painter, Helena; Sanchez, Javier; Salinas, Kelcy; Mamuyac, Cherifer; Marudamuthu, Cindy; Wrigley, Fenella; Corrah, Tumena; et al. (2020-09)
    • Exploratory analysis on the need for an ECMO eCPR service in South East London

      Auzinger, G.; Best, T.; Gelandt, E.; Hurst, T.; Kakar, V.; Loveridge, R.; Morgan, L.; Nevett, Joanne; Park, C.; Patel, S.; et al. (2016-11)
    • Focused cardiac ultrasound in out-of-hospital cardiac arrest: a literature review

      Brown, Nick; Quinn, Tom (2021-01-02)
      Focused cardiac ultrasound (FoCUS) is emerging in emergency medical systems, particularly in the context of prognostication in out-of-hospital cardiac arrest. However, FoCUS has not been formally incorporated into UK guidelines because of a lack of evidence. Furthermore, concerns have been raised that FoCUS can distract people from providing other essential and evidenced elements of care. This broad literature search aims to shed light on the practice of FoCUS in cardiac arrest by reviewing articles related to in-hospital and out-of-hospital practice. The findings are conspicuous by the lack of high-quality studies, particularly regarding prognostication. Association between ultrasound findings and outcome are asserted, as is the feasibility of paramedic use of FoCUS, although the evidence is from small and non-randomised studies and subject to bias. Abstract published with permission.
    • Framework for assessment of the 12 lead ECG in transient loss of consciousness

      Edwards, Timothy (2012-11)
      Abstract published with permission. Following the introduction of pre-hospital thrombolysis, the acquisition and interpretation of the 12 lead ECG has become a routine part of UK paramedic practice. Although there is a growing body of evidence that confirms the diagnostic ability of paramedics in this area, little is known regarding the ability of paramedics to scrutinise the 12 lead ECG for other abnormalities. Recent publication of NICE guidance (NICE, 2010) relating to transient loss of consciousness (T-LOC) requires practitioners responsible for assessment of the 12 lead ECG post T-LOC to be competent in identifying a range of abnormalities. This paper describes a novel assessment framework in the form of a mnemonic designed to assist paramedic students in scrutinising the ECG for abnormalities post T-LOC. The need for further research to validate this assessment framework in educational and clinical settings is emphasised.
    • Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

      Edwards, Melanie J.; Bassett, Gary; Sinden, Levi; Fothergill, Rachael (2015-05)
      Background A minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients. Objectives The present study aimed to (i) profile frequent callers to the ambulance service and (ii) evaluate the impact of a case management interventional approach on frequent caller behaviour. Methods A retrospective review of data from a 2-year period (from 1 April 2009 to 31 March 2011) was conducted. Patients were included in the analysis if they had been accepted for case management intervention by the Patient-Centred Action Team during this period and met the study inclusion criteria. Results The review identified 110 frequent callers who met the study inclusion criteria. The majority of frequent callers (86%) had multiple and complex reasons for calling, including frequent medical need, acute or chronic mental health condition, older age and unmet personal or social care needs. In the majority of cases (82%), multiple interventional strategies were required. A significant reduction in median call volume was observed from preintervention to postintervention (from five calls/month to zero calls/month). Conclusions Effective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour. https://emj.bmj.com/content/32/5/392.long 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-2013-203496