• Impact of Early (≤24 H) Versus Delayed (>24 H) Intervention in Patients With non-ST Segment Elevation Myocardial Infarction: An Observational Study of 20,882 Patients From the London Heart Attack Group

      Panoulas, Vasileios; Rathod, Krishnaraj S.; Jain, Ajay K.; Firoozi, Sam; Nevett, Joanne; Kalra, Sundeep Singh; Malik, Iqbal S.; Mathur, Anthony; Redwood, Simon; MacCarthy, Philip A.; et al. (2020-06-03)
    • Impact of inter-hospital transfer for primary percutaneous coronary intervention on survival (10 108 STEMI patients from the London Heart Attack Group)

      Jones, Daniel A.; Bromage, D.I.; Rathod, Krishnaraj S.; Lim, Pitt; Virdi, Gurkamal K.; Jain, A.J.; Singh Kalra, S.; Crake, Tom; Meier, Pascal; Astroulakis, Zoe; et al. (2013-05)
      Background Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated whether direct transfer to a cardiac centre performing primary percutaneous coronary intervention (PPCI) leads to improved survival compared with transfer via a non-PPCI performing hospital in STEMI patients in a regional network. Methods This was an observational cohort study of 10 108 patients with STEMI treated with PPCI between 2004 and 2011 at eight tertiary cardiac centres across London, UK. Patient ’s details were recorded at the time of the procedure into the British Cardiac Intervention Society (BCIS) database. Outcome was assessed by all-cause mortality. Anonymous datasets from the eight centres were merged for analysis. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (IQR range 1.2 – 4.6 years). Results 6492 patients (64.2%) were transferred directly to a PCI performing centre (direct) and 3616, (35.8%) were transferred via a non-PCI performing centre (indirect). There were higher rates of previous MI and previous CABG in the indirect group, with higher rates of poor LV function in the direct group (table 1). Median time to reperfusion (symptom to balloon) in transferred patients was 58 min longer compared to patients admitted directly (p<0.001). However, symptom to first hospital door times were similar. Transferred patients had significantly lower rates of infarct-related artery (IRA) TIMI 0 flow (54.5% vs 62.9%, p<0.0001) and higher rates of IRA TIMI 3 flow (17% vs 10.7%, p>0.0001) at presentation compared to those transferred directly. Kaplan-Meier analysis demonstrated no significant difference in mortality rates between patients with and without transfer (12.3% direct vs 14.3% indirect, p=0.060). Age-adjusted Cox analysis revealed inter-hospital transfer for PPCI was associated with all cause mortality (HR 0.89 (95% CI 0.79 to 0.99)), however this was not maintained after multivariate adjustment (HR 0.84 (95% CI 0.62 to 1.14)). Conclusions In this large registry survival appear comparable in patients with STEMI admitted directly versus transferred for primary PCI. This is despite longer symptom to balloon times. This unexpected finding may reflect the earlier initiation of medical therapy (eg, anti-platelets and GpIIb/IIIa receptor inhibitors) and earlier pharmacological reperfusion, reflected by lower IRA TIMI 0 rates at angiography in the patients transferred from a non-PCI hospital. https://heart.bmj.com/content/heartjnl/99/suppl_2/A22.2.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/heartjnl-2013-304019.30
    • The impact of shift work on emergency medical dispatching

      Roshanzamir, S.; Heward, Andy; Glucksman, Ed. (2006-04)
      Healthcare professionals are required to work to consistently high standards 24 hours a day, 365 days a year necessitating shift work to be employed. Shift work is often perceived to result in disruption to the worker, manifesting itself in terms of sleep, health, and social disruption, as well as job performance, standards, and safety, with substantial differences in fatigue identified between day and night shift workers. https://emj.bmj.com/content/23/4/321 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.2005.032938
    • Impact of the terrorist atrocities of 7 July 2005 on the London Ambulance Services incident volume

      Yates, C.; Heward, Andy; Glucksman, E. (2006-12)
      During the past 20 years, there have been numerous terrorist atrocities and other major incidents within the boundaries covered by the London Ambulance Service (LAS) NHS Trust. Historic LAS records and anecdotal feelings suggest that the demands placed on the LAS during these incidents were significantly reduced, with fewer 999 calls received, but no work had previously been undertaken to evidence this suggestion. 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
    • Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model

      Hunter, Rachael M.; Davie, Charles; Rudd, Anthony; Thompson, Alan; Walker, Hilary; Thomson, Neil; Mountford, James; Schwamm, Lee; Deanfield, John; Thompson, Kerry; et al. (2013-08)
    • Implementing emergency ambulance re-design

      Benger, Jonathan; Matthews, Ed; Harrow, Dale; Dean, Dixie; King, Dominic; Emergency Ambulance Re-design Working Group (2012-06-11)
    • The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review

      Barratt, Helen; Wilson, Mark H.; Moore, Fionna; Raine, Rosalind (2010-03-19)
      Head injury is an important cause of death among young adults in the UK, and a significant burden on NHS resources. However, management is inconsistent, governed largely by local resources. The latest version of the NICE head injury guidelines suggests that more patients with traumatic brain injury should be transferred to receive specialist care. However, this raises issues about the capacity of regional neurosurgical units, particularly to accommodate patients who do not require surgical intervention. Objectives To critically evaluate the basis of the NICE recommendations about transfer for neurosurgical care, and examine the configuration of specialist services to assess the implications of increasing the existing number of transfers. Methods A systematic literature review was conducted of articles discussing the provision of emergency neurosurgical care for adult head injuries in the UK. Results Fifty-eight papers met the criteria for inclusion in the literature review, including seven papers cited in the NICE guidance. Fifty-one papers related to neurosurgical care, including papers on bed occupancy, transfer times and transfer policies. Conclusions The evidence NICE cited is of variable quality. Much of the research was conducted outside the UK, which raises questions about its relevance to the NHS. Care of traumatic brain injuries in the UK is already hampered by the inadequate capacity of regional neurosurgical units to meet demand, and transferring more patients would be likely to exacerbate this. Increasing the number of transfers could also worsen inequalities of access for other groups, such as elective patients, particularly in areas where facilities are most stretched. https://emj.bmj.com/content/27/3/173. 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.2009.075382
    • 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