RSS 1.0Publications - North East Ambulance Service
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Temperature management of babies born in the prehospital setting: an analysis of call-handler advice and staff and patient viewsBackground Following prehospital birth, babies can become hypothermic within minutes, sometimes before paramedics arrive. The risk of the baby dying increases by at least 28% for every degree that their temperature drops below <36.5°C. The earlier we can provide effective warming interventions, the lower the risk of poor outcomes. The aim of this project was to 1), examine the neonatal temperature management advice given to people calling 999 about a prehospital birth in the UK and 2), explore NHS staff and patient views about the content and accessibility of advice given. Methods All 999 calls between January 2021-January 2022 were searched by the Clinical Information and Records teams at two ambulance services using the two different triage systems (AMPDS and NHS Pathways). Thirty eligible calls were selected from postcodes with varying levels of deprivation and passed to the study team for content analysis. Nine focus groups were held with 18 NHS staff (paramedics, midwives, neonatal nurses/doctors, call-handlers), and 22 members of the public who had experienced prehospital birth, to discuss the content and accessibility of the advice given. Results Five themes were identified as potential barriers to good quality neonatal temperature management: confusing or conflicting advice on where the baby should be placed following birth, vague or unclear instructions on warming the baby, the timing of temperature management advice, the priority given to other instructions, and a lack of importance placed on neonatal temperature. Participants suggested a number of simple changes to advice, including increased focus on the importance of neonatal temperature, encouraging skin-to-skin contact, and providing specific advice on warming the baby. Conclusions There is an opportunity to improve the neonatal temperature management advice given by 999 call-handlers during calls related to prehospital birth. This could reduce the number of babies arriving at hospital hypothermic, therefore improving outcomes. https://doi.org/10.1136/emermed-2023-999.7 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/
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Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment: a systematic reviewAround 25% of patients who had a stroke do not present with typical ‘face, arm, speech’ symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives). https://emj.bmj.com/content/38/5/387. 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-2020-209607
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Use of flumazenil to treat poisoning in prehospital careA discussion exploring antidotes available for drug toxicity is presented, focusing specifically on flumazenil, within the prehospital setting. This critical review was carried out to establish whether this antidote would be useful in prehospital care and details the potential for practice development for the role of the ambulance-based paramedic. Analysis suggests that further research is required in order to determine the requisite of this antidote. Abstract published with permission.
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Research and development : a new direction for NEASThe Department of Health has recently introduced a new national strategic direction for research and development (R&D) across the National Health Service (NHS). One of the major developments is the National Institute for Health Research (NIHR) which provides a framework to position, manage and maintain world-class research, staff and infrastructure in the NHS. This national framework is having a substantial effect on driving and shaping the infrastructure of R&D departments within Ambulance NHS Trusts. This article provides an overview of the national development and highlights some of the major consequential developments for the North East Ambulance Service NHS Trust (NEAS). Abstract published with permission.
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Hyperventilation in cardiac arrest—a systematic review and narrative synthesisResuscitation guidelines recommend delivering ventilations at a rate of 10 per minute. However, hyperventilation is commonly reported during out-of-hospital cardiac arrest resuscitation efforts, and the impact of this on patient outcomes is unclear. This review explores the reported rates, causes and patient outcomes of hyperventilation in the management of out-of-hospital cardiac arrest. Abstract published with permission.
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The RESearch PARamedic Experience (RESPARE) study: a qualitative study exploring the experiences of research paramedics working in the United KingdomBackground: The research paramedic position is a relatively niche role undertaken by a small number of paramedics who support, deliver and promote research. Research paramedic roles provide opportunities to develop talented researchers who are recognised as vital elements of developing a research culture within ambulance services. The benefits of research-active clinicians have been recognised at a national level. The aim of this study was to explore the experience of people who work, or have worked, as research paramedics. Methods: A generic qualitative approach underpinned by phenomenological concepts was used. Volunteers were recruited via ambulance research leads and social media. Online focus groups allowed participants to discuss their roles with peers who may be geographically distant. Semi-structured interviews expanded on the focus group findings. Data were recorded, transcribed verbatim and analysed using framework analysis. Results: Eighteen paramedics (66% female, median involvement in research six (interquartile range 2‐7) years) representing eight English NHS ambulance trusts participated in three focus groups and five interviews lasting around one hour, in November and December 2021. Six key themes were identified: starting as a research paramedic; barriers and facilitators to working as a research paramedic; research careers; opportunities; the community (support and networking); and the value of a clinical identity. Conclusions: Many research paramedics had similar experiences in terms of starting their career by delivering research for large studies, then building on this experience and the networks they create to develop their own research. There are common organisational and financial barriers to working as a research paramedic. Career progression in research beyond the research paramedic role is not well defined, but often involves building links outside of the ambulance service. Abstract published with permission.
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Rural versus urban out-of-hospital cardiac arrest response, treatment and outcomes in the North East of England from 2018 to 2019Introduction: Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency. There is international evidence to suggest that rural regions experience worse OHCA outcomes, such as reduced survival rates. The aim of this study was to quantitatively review and compare the OHCA response, treatment and pre-hospital outcomes in a single-centre ambulance service over a 1-year period in urban and rural areas. Methods: This study used retrospective OHCA audit data from the North East Ambulance Service NHS Foundation Trust, from April 2018 to April 2019, comparing OHCA response, treatment and return of spontaneous circulation (ROSC) data in relation to urban or rural classification status, using the UK government urban‐rural classification tool. Results: A total of 1295 urban cases and 319 rural cases were compared. Bystander public-access defibrillator (PAD) use was higher in rural areas in comparison to urban areas (20/319 (6.3%) vs 47/1295 (3.6%); p = 0.03). The mean ambulance response time was slower in rural areas (10:43 minutes (n = 319) (SD ± 8.2) vs 07:35 minutes (n = 1295) (SD ± 7.1); p = < 0.01). Despite this, overall ROSC rates at hospital were similar between the groups, with no statistically significant difference (rural: 87/319 (27.3%) vs urban: 409/1295 (31.6%); p = 0.14). A further sub-group analysis of initially shockable OHCA cases showed slower ambulance response times in rural areas (10:45 minutes (n = 68) (SD ± 12.3) vs 07:55 minutes (n = 245) (SD ± 5.5); p = < 0.01) and that rural cases experienced lower ROSC at hospital rates (31/68 (45.6%) vs 151/245 (61.6%); p = 0.02). Conclusion: This report showed differences in OHCA response and outcomes between rural and urban settings. In the shockable OHCA sub-group analysis, rural areas had slower ambulance response times and lower ROSC rates. The longer ambulance response times in the rural shockable OHCA group could be a factor in the reduced ROSC rates. Linking hospital survival data should be used in future research to explore this area further. Abstract published with permission.
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Prognostic value of lactate in out-of-hospital cardiac arrest: a prospective cohort studyBackground: The prognostic role of lactate in out-of-hospital cardiac arrest (OHCA) remains unclear. Aims: To explore serum lactate as a predictor of return of spontaneous circulation in patients experiencing OHCA after arrival at hospital. Methods: This 13-month prospective observational cohort study involved patients aged ≥18 years. Serum lactate levels were measured during cardiopulmonary resuscitation before ROSC. Patients were divided into two groups by lactate level: Group 1, low (≤9.9 mmol/l) and Group 2, high (≥10 mmol/l). Findings: 105 patients were included, 50 in group 1 and 55 group 2. Median lactate were 7.4 mmol/l and 14.2 mmol/l respectively. More patients in group 1 were found with ventricular fibrillation (40% versus 14.5%; P≤0.01), obtained ROSC more quickly (37 minutes 38 seconds versus 39 minutes 13 seconds; P=0.79) and achieved short-term survival (survived >24 hours) (40% versus 23.5%; P=0.32), versus group 2; prediction of survival did not reach statistical significance. Conclusion: Lower lactate levels in OHCA appear to be associated with better short-term outcomes but the cut-off points regarding survival remain unclear. Abstract published with permission.
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Predicting conveyance to the emergency department for older adults who fallBackground: Falls are frequent in older adults and are associated with high mortality, morbidity and immobility. Many patients can be managed in the community, but some will require conveyance to the emergency department (ED). Aims: This study aims to identify predictive characteristics of conveyance to the ED after a fall. Methods: A cross-sectional study between December 2018 and September 2020 involved patients attended by a falls rapid response service. Eligible patients were aged ≥60 years with mental capacity, had experienced a fall and were living within the relevant geographical area. Findings: 426 patients were enrolled, with a mean age of 82.61 years (SD 8.4; range 60–99 years) and 60.7% were women. Predictive characteristics of conveyance were an injurious fall or pain (OR 8.25; 95% CI (4.89–14.50); P≤0.01) and having been lying for a long time (OR 1.6; 95% CI (1.00–2.56); P=0.04). Conclusion: It is possible to identify predictors of conveyance to the ED; therefore, an undifferentiated approach towards dispatching the falls rapid response service to all older adults who fall is unwarranted. Abstract published with permission.
