Recent Submissions

  • Ambulance service call handler and clinician identification of stroke in North East Ambulance Service

    McClelland, Graham; Burrow, Emma (2021-09)
    Emergency medical services (EMS) are the first point of contact for most acute stroke patients. The EMS response is triggered by ambulance call handlers who triage calls and then an appropriate response is allocated. Early recognition of stroke is vital to minimise the call to hospital time as the availability and effectiveness of reperfusion therapies are time dependent. Minimising the pre-hospital phase by accurate call handler stroke identification, short EMS on-scene times and rapid access to specialist stroke care is vital. The aims of this study were to evaluate stroke identification by call handlers and clinicians in North East Ambulance Service (NEAS) and report on-scene times for suspected stroke patients. Abstract published with permission.
  • Hangings attended by emergency medical services: a scoping review

    Shaw, Gary; Thompson, Lee; McClelland, Graham (2021-03)
    n the United Kingdom (UK) there were 6507 deaths by suicide in 2018, with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted. Trauma audits conducted by North East Ambulance Service NHS Foundation Trust have identified an increased trend in hanging cases, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice. Abstract published with permission.
  • Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT

    Perkins, Gavin; Ji, Chen; Achana, Felix; Black, John J.M.; Charlton, Karl; Crawford, James; de Paeztron, Adam; Deakin, Charles; Docherty, Mark; Finn, Judith; et al. (2021-04)
  • The impact of introducing real time feedback on ventilation rate and tidal volume by ambulance clinicians in the North East in cardiac arrest simulations

    Charlton, Karl; McClelland, Graham; Millican, Karen; Haworth, Daniel; Aitken-Fell, Paul; Norton, Michael (2021-05-10)
  • Defining major trauma: a Delphi study

    Thompson, Lee; Hill, Michael; Lecky, Fiona; Shaw, Gary (2021-05-10)
  • The influence of paramedic assessment on emergency transportation of stroke patients

    Price, Christopher; Duckett, Jay; Cessford, C.; Ford, Gary A. (2008-09-01)
  • A systematic review of the clinical and demographic characteristics of adult patients with stroke mimics

    McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher (2015-09-01)
  • Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis

    Lally, Joanne; Vaittinen, Anu; McClelland, Graham; Price, Christopher; Shaw, Lisa; Ford, Gary A.; Flynn, Darren; Exley, Catherine (2020-06-16)
    Background Intravenous thrombolysis is a key element of emergency treatment for acute ischaemic stroke, but hospital service delivery is variable. The Paramedic Acute Stroke Treatment Assessment (PASTA) multicentre cluster randomised controlled trial evaluated whether an enhanced paramedic-initiated stroke assessment pathway could improve thrombolysis volume. This paper reports the findings of a parallel process evaluation which explored intervention paramedics’ experience of delivering the enhanced assessment. Methods Interviewees were recruited from 453 trained intervention paramedics across three UK ambulance services hosting the trial: North East, North West and Welsh Ambulance Services. A semistructured interview guide aimed to (1) explore the stroke-specific assessment and handover procedures which were part of the PASTA pathway and (2) enable paramedics to share relevant views about expanding their role and any barriers/enablers they encountered. Interviews were audiorecorded, transcribed verbatim and analysed following the principles of the constant comparative method. Results Twenty-six interviews were conducted (11 North East, 10 North West and 5 Wales). Iterative data analysis identified four key themes, which reflected paramedics’ experiences at different stages of the care pathway: (1) Enhanced assessment at scene: paramedics felt this improved their skillset and confidence. (2) Prealert to hospital: a mixed experience dependent on receiving hospital staff. (3) Handover to hospital team: standardisation of format was viewed as the primary benefit of the PASTA pathway. (4) Assisting in hospital and feedback: due to professional boundaries, paramedics found these aspects harder to achieve, although feedback from the clinical team was valued when available. Conclusion Paramedics believed that the PASTA pathway enhanced their skills and the emergency care of stroke patients, but a continuing clinical role postadmission was challenging. Future studies should consider whether interdisciplinary training is needed to enable more radical extension of professional boundaries for paramedics. https://emj.bmj.com/content/early/2020/06/16/emermed-2019-209392. 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/emermed-2019-209392
  • Feasibility of phenytoin as a paramedic-led second-line anti-epileptic drug

    Morrison, Luke (2020-09-07)
    Background: Convulsive status epilepticus (CSE) is a medical emergency that is commonly encountered in the prehospital setting. In almost all prehospital settings, treatment is limited to benzodiazepines even though the standard of care in emergency departments includes second-line agents such as phenytoin. Methods: A literature search was conducted using PubMed and Google Scholar using the search terms ‘phenytoin’, ‘seizure’ or ‘convulsive’ and ‘prehospital’, ‘EMS’ or ‘ambulance’ or ‘emergency department’. Five articles were analysed and a narrative review formed. Results: Phenytoin is an effective and commonly used second-line anti-epileptic agent but there is a distinct lack of evidence on prehospital phenytoin. Phasing the introduction of phenytoin into practice while simultaneously running a well-designed research trial could provide data for prehospital providers and the wider health community. Conclusion: Management of CSE will continue to present challenges to prehospital providers. Promoting the introduction of phenytoin to select patients, administered by advanced clinicians, could be an excellent opportunity to generate much-needed clinical data and potentially reduce morbidity and mortality in CSE. Abstract published with permission.
  • Development and impact of a dedicated cardiac arrest response unit in a UK regional ambulance service

    Younger, Paul; McClelland, Graham; Fell, Paul (2015-05-19)
    Background Survival rates from out-of-hospital cardiac arrest (OHCA) vary, with figures from 2% to 12% reported nationally. Our ambulance service introduced a dedicated cardiac arrest response unit (CARU) as a trial in order to improve local patient outcomes by focussing training, extending the scope of practice and increasing exposure to cardiac arrests. CARU launched in January 2014 using a rapid response car staffed by senior paramedics responding to cardiac arrests within a 19 minute radius of their location⇓. VIEW INLINE VIEW POPUP Methods This work describes the development and impact of CARU during the initial six months (10/01/14 to 09/07/2014) of operations using prospectively collected data on all cases attended. Results CARU activated to 165 calls and attended 65% (n=107). 50% (n=54) of the cases attended were cardiac arrests where resuscitation was attempted. Return of Spontaneous Circulation (ROSC) was achieved during pre-hospital resuscitation in 52% (n=28) of cases. Patient outcomes are reported compared with service data for January to June 2014 inclusive and one year of historical data from the regional OHCA registry: Conclusions Based on these figures CARU appears to have a positive impact on ROSC and a significant impact on survival to discharge rates compared with the rest of the service (p<0.01, Fisher's exact test). Further work is needed to explore how CARU delivers this impact and how the CARU model can be implemented beyond the trial setting in a sustainable fashion. https://emj.bmj.com/content/32/6/503.2. 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/emermed-2015-204979.2
  • A two armed, randomised, controlled exploratory study of adding the ambugard cleaning system to normal deep cleaning procedures in a regional ambulance service

    McClelland, Graham; Charlton, Karl; Mains, Jacqueline; Millican, Karen; Cullerton, Caroline (2020-10)
    Ambulance services transport patients with infections and diseases and could pose a cross transmission risk to patients and staff through environmental contamination. The literature suggests that environmental pathogens are present on ambulances, cleaning is inconsistent and patient/staff impact is difficult to quantify. Eco-Mist developed a dry misting decontamination system for ambulance use called AmbuGard which works in <30 minutes and is 99.9999% effective against common pathogens. The research question is ‘What pathogens are present on North East Ambulance Service ambulances and what impact does adding the AmbuGard to the deep cleaning process make?’ https://emj.bmj.com/content/37/10/e4.1 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/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.5
  • Modeling outcomes following redirection of emergency stroke admissions from ten local stroke units to two neuroscience centres

    McMeekin, Peter; Gray, J.; Price, Christopher; Rae, Victoria; Duckett, Jay; Wood, R.; Rodgers, H.; Ford, A. (2012-12-06)
  • Effect of an Enhanced Paramedic Acute Stroke Treatment Assessment on Thrombolysis Delivery During Emergency Stroke Care: A Cluster Randomized Clinical Trial

    Price, Christopher; Shaw, L.; Islam, Saiful; Javanbakht, Mehdi; Watkins, Alan; McKeekin, Peter; Snooks, Helen; Flynn, Darren; Francis, Richard; Lakey, Rachel; et al. (2020-04-13)
  • Effect of an Enhanced Paramedic Acute Stroke Treatment Assessment on Thrombolysis Delivery During Emergency Stroke Care: A Cluster Randomized Clinical Trial

    Price, Christopher; Shaw, Lisa; Islam, Saiful; Javanbakht, Mehdi; Watkins, Alan; McMeakin, Peter; Snooks, Helen; Flynn, Darren; Francis, Richard; Lakey, Rachel; et al. (2020-07)
  • Impact of the COVID-19 lockdown on hangings attended by emergency medical services

    McClelland, Graham; Shaw, Gary; Thompson, Lee; Wilson, Nina; Grayling, Michael (2020-10-24)
  • Ambulance documentation of stroke symptoms during the UK COVID-19 ‘Stay at Home’ message

    McClelland, Graham; Wilson, Nina; Shaw, Lisa; Grayling, Michael; Haworth, Daniel; Price, Christopher (2020-11-16)
    On 23 March 2020 the UK government urged the public to ‘Stay Home, Protect the NHS, Save Lives’ in order to reduce consequences from the COVID-19 pandemic.1 Three large National Health Service (NHS) stroke units subsequently reported a 16% (95% CI 27.2 to 3.2) decrease in the weekly trend for stroke admissions during March–April compared with January–February 2020. https://emj.bmj.com/content/early/2020/11/16/emermed-2020-210319 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/emermed-2020-210319
  • Is weight just a number? The accuracy of UK ambulance paediatric weight guidance – findings from a cross sectional study

    Charlton, Karl; Capsey, Matt; Moat, Christopher (2020-09-25)
    Background The weight of children is the cornerstone of their clinical management. It determines fluid quantities, drug dosages and defibrillation power, which are administered on a per kilogram basis. Gold standard care for all paediatric patients who attend hospital involves being weighed using scales. This is not possible in the out of hospital setting, where weight derives from a guidance table based upon age. No evidence exists to indicate if the page by age approach indicated in current ambulance guidelines meets the reference standard of 70% of estimations within 10% of actual weight and 95% within 20% of actual weight. Methods We used a cross sectional study design and collected data from a convenience sample of children who attended the outpatient’s department of a major hospital in England between July and September 2019. All children aged between one and eleven years who were weighed were eligible for inclusion. Outcomes were to determine if the page by age approach meets the reference standard and to determine any implications for care. Results Three hundred and forty-one children were included in this study. Each age group consisted of varying numbers of children. 50.5% (172/341) of the sample were female. Observed weights ranged from 8.28 to 82.70 kg (median 20.60 kg). The mean weight of girls versus boys was 24.69 kg and 23.39 kg respectively (95% CI -4.12–1.32, p=0.3123). Observed weights were greater than the page for age guidance in all age groups and the accuracy of this approach diminishes with age. Conclusion Page by age weight guidance does not meet the reference standard. Most paediatric prehospital care is administered by age and not weight. In the absence of an accurate weight, ambulance clinicians should continue to use the page for age system, although the gold standard remains to use an accurate weight measurement. https://emj.bmj.com/content/37/10/e9.1. 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. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.17

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