• How do paramedics learn to intubate?

      McClelland, Graham; Younger, Paul; Haworth, Daniel (2016-05)
      Abstract published with permission. A short cut review was carried out to establish what education and training are required for paramedics to gain initial competence in the skill of endotracheal intubation. Nineteen studies were identified with relevance to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is difficult to isolate intubation from the wider subject of airway management and the range of skills and techniques necessary to safely secure the airway in the prehospital setting. The evidence presented suggests that at least 25–35 intubations are necessary, as part of a wider programme of training, to gain initial competence in this skill.
    • A qualitative investigation into paramedics' thoughts about the introduction of national early warning scores

      McClelland, Graham; Haworth, Daniel (2016-09)
      Background The National Early Warning Score (NEWS) is a simple, rapid assessment tool developed by the Royal College of Physicians to standardise the assessment and monitoring of acutely ill patients and facilitate communication across settings. Ambulance Service introduced NEWS in 2013/14. Previous work in this area showed that paramedics were not using NEWS in practice so this study explored the reasons why and how paramedics use, or don’t use, NEWS in practice. Methods Qualitative study using a pragmatic approach. Semi-structured interviews were conducted on a purposive volunteer sample of 8 paramedics with a range of roles, locations and lengths of service. Interviews were digitally recorded and transcribed for analysis. Five stage framework analysis commenced in parallel with data collection. Results Two main themes emerged from the data. The first theme was when and how paramedics used NEWS in their decision making. All participants thought that they, and their peers, collected all the observations necessary to calculate a NEWS but that it didn’t enter their thoughts until after decisions had been made and were being documented. Participants saw NEWS as a tool to support their decisions but also thought NEWS may be beneficial for triggering decisions by non-paramedic ambulance staff. The second theme was how interactions with other healthcare professionals impacted on paramedics’ use of NEWS. The reception participants received when handing a NEWS over at hospital had a strong influence on their continuing use of NEWS. The perception that Emergency Department staff weren’t interested in NEWS acted as a negative influence on pre-hospital practice apart from one area where the local hospital encouraged the use of NEWS which had a localised positive reinforcing effect. Conclusions Paramedics use NEWS to support rather than trigger decisions. The perceived importance placed on information handed over at hospital influences paramedics pre-hospital practice. https://emj.bmj.com/content/emermed/33/9/e2.3.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/emermed-2016-206139.10
    • A qualitative investigation into paramedics' thoughts about the introduction of the National Early Warning Score

      McClelland, Graham; Haworth, Daniel (2016-05)
      Abstract published with permission. Introduction – The National Early Warning Score is a simple, rapid assessment tool developed by the Royal College of Physicians to standardise the assessment and monitoring of acutely ill patients. The North East Ambulance Service NHS Foundation Trust introduced the National Early Warning Score in 2013/2014 to improve communication between the pre-hospital and hospital setting; however, there was and remains a lack of pre-hospital evidence that supports the value of the National Early Warning Score. A previous study showed that the utilisation of the National Early Warning Score by North East Ambulance Service NHS Foundation Trust paramedics was low. Objective – To investigate what North East Ambulance Service NHS Foundation Trust paramedics think about the National Early Warning Score and its use in practice. Design – Qualitative study using a pragmatic approach with recorded and transcribed semistructured interviews. Framework analysis commenced in parallel with data collection. Participants – A purposive volunteer sample of eight paramedics with a range of roles, locations, educational backgrounds and lengths of service. Results – Three major themes emerged from the data: applying the National Early Warning Score in practice, how the National Early Warning Score was used in decision making and how paramedic practice was subject to external influences. Conclusions – This study gives some insight into how paramedics use the National Early Warning Score in pre-hospital care and how they integrate it into their decision making. The findings also demonstrate the influence that external agencies, primarily the receiving acute hospitals, can have on pre-hospital practice.
    • A service evaluation of a dedicated pre-hospital cardiac arrest response unit in the North East of England

      McClelland, Graham; Younger, Paul; Haworth, Daniel; Gospel, Amy; Aitken-Fell, Paul (2016-09)
      Abstract published with permission. Aim ‐ This article describes the introduction of a specialist cardiac arrest response unit by the North East Ambulance Service NHS Foundation Trust, with the aim of improving treatment and outcomes of out-of-hospital cardiac arrest patients, in the North East of England. Methods ‐ This study is a retrospective analysis of prospectively collected data, describing all cases where the cardiac arrest response unit was dispatched in the first 12 months of operation (January 2014 to January 2015). Results ‐ The cardiac arrest response unit was activated 333 times during the first year of operation and attended 164 out-of-hospital cardiac arrest patients. The cardiac arrest response unit demonstrated a significant impact on return of spontaneous circulation sustained to hospital (OR 1.74 (95% CI 1.19‐2.54), p = 0.004) and survival to discharge (OR 2.08 (95% CI 1.12‐3.84), p = 0.017) compared with the rest of the North East Ambulance Service NHS Foundation Trust. Conclusion ‐ The cardiac arrest response unit project demonstrated an improvement in return of spontaneous circulation and survival to discharge compared to current standard care. The specific mechanism, or mechanisms, by which the cardiac arrest response unit influences patient outcomes remain to be determined.