• 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)
    • Intravenous versus oral paracetamol in a UK ambulance service: a case control study

      Charlton, Karl; Limmer, Matthew; Moore, Hayley (2020-06-01)
      Abstract published with permission Objectives: To determine the effectiveness of intravenous versus oral paracetamol (acetaminophen) in the management of acute pain in the out-of-hospital setting. Methods: We extracted ambulance electronic patient care records for all patients who received 1 g intravenous paracetamol throughout January 2019, and case matched these by sex and age with consecutive patients who received 1 g oral paracetamol over the same time period. Eligible for inclusion were all patients aged ≥ 18 who received 1 g paracetamol for acute pain and who were transported to the emergency department (ED). The primary outcome was the mean reduction in pain score using the numeric rating scale (NRS), with a reduction of 2 or more accepted as clinically significant. Results: 80 care records were eligible for analysis; 40 patients received intravenous and 40 patients received oral paracetamol. The mean age of both groups was 54 years (± 3 years) and 67.5% (n = 54) were female. Patients receiving intravenous paracetamol had a clinically significant mean (SD) improved pain score compared to those receiving oral paracetamol, 2.02 (1.64) versus 0.75 (1.76), respectively [p = 0.0013]. 13/40 (32.5%) patients who received intravenous paracetamol saw an improved pain score of ≥ 2 compared to 8/40 (20%) who received oral paracetamol. No patients received additional analgesia or reported any adverse symptoms. Abdominal pain, infection and trauma were the most common causes of pain in both groups. Conclusion: Our study suggests that intravenous paracetamol is more effective than oral paracetamol when managing acute pain in the out-of-hospital setting. Our findings support further investigation of the role of paracetamol in paramedic practice using more robust methods.
    • 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
    • A rapid response falls service – a new solution to a growing problem

      Charlton, Karl (2019-09-24)
      Background Falls are frequent in older people and are the primary cause of injury in adults aged 65+. Falls are associated with high mortality, morbidity and immobility. Many people who fall become frequent fallers, increasing the risk of serious injury; subsequently falls prevention is an NHS priority. A new rapid response falls service comprising of a Paramedic and Occupational Therapist was launched on 30th November 2018 but no evidence exists to determine the clinical or cost effectiveness of this intervention. This research aims to: Evaluate the rate of hospital admission for patients who pass through the intervention Evaluate the cost effectiveness of the intervention. Determine the prevalence of risk factors for falling in the study group & determine any differences between those admitted to hospital and those who are not Methods This study is an observational, prospective cohort study and aims to recruit all patients who pass through the intervention who meet the eligibility criteria. Calculations indicate a sample size of 677. With informed consent, we will collect anonymised data relating to each patient, their care episode and ambulance despatch data. These data will answer the aims of this study and provide detail on how various patient groups differ. Research ethics committee and HRA approval has been granted. Results Interim results will be presented in the form of graphs, frequencies, percentages and mean values to demonstrate the rate of hospital admission, cost effectiveness of the intervention and disease prevalence for the study group. A narrative will contextualise findings to date and generate discussion. We will provide the rate of consent, dissent and withdrawal for the cohort. Conclusions A summary of findings to date will be provided as well as implications for patients and the NHS. Limitations of this work will be discussed and opportunities for future research highlighted., https://emj.bmj.com/content/36/10/e5.3 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-2019-999abs.10
    • 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