• The costs of falls in the community to the North East Ambulance Service

      Newton, Julia L.; Kyle, P.; Liversidge, P.; Robinson, G.; Wilton, K.; Reeve, P. (2006-05-19)
      This study set out to quantify the immediate costs to the North East Ambulance Service (NEAS) of attending to fallers. https://emj.bmj.com/content/23/6/479 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 10.1136/emj.2005.028803
    • Views of ambulance paramedics on involvement in stroke research

      Mackintosh, J. E.; Burges Watson, D.; Cessford, C.; Ford, Gary A.; Murtagh, M. J.; Price, C. (2009-12-01)
    • National research guidance and support for Trusts

      McLure, Sally; McColl, Elaine; Mason, James (2009-12-18)
      The Research Design Service (RDS) is one of the key components of the National Institute for Health Research (NIHR) which aims to position, manage and maintain world-class research in the National Health Service (NHS). Formed in 2008 as a component of the Department of Health's Research and Development (R&D) Strategy, Best Research for Best Health (Department of Health, 2006), the NIHR RDS is a major new initiative in which the NIHR will be investing around £50 million over 5 years. This article provides an overview of the RDS and highlights some of the major developments and consequential opportunities for Ambulance Trusts in England. Abstract published with permission.
    • Improving systems for research management and governance

      McLure, Sally; Dorgan, Sharon; Smith, Justine (2010-02)
      The North East Ambulance Service NHS Trust (NEAS) is committed to the implementation of a number of nationally proposed initiatives following the introduction of the research strategy Best Research for Best Health (Department of Health, 2006). The ambitious strategy introduces several measures to improve the research environment and ensure that studies commence more efficiently. This article provides an overview of the national initiatives, i.e. the Research Passport Scheme and the National Institute for Health Research Coordinated System for gaining NHS Permissions. These initiatives aim to strengthen and streamline research management and governance across England, which NEAS are actively embracing. Abstract published with permission.
    • Incidence of peri-opiate nausea and vomiting in the pre-hospital setting: an intermediate analysis

      Campbell, Gareth; Woollard, Malcolm; McLure, Sally; Duckett, Jay; Newcombe, Robert; Clarke, Tom (2011-03)
      Background Intravenous morphine is the preferred drug for the treatment of moderate to severe pain by paramedics. Nausea and vomiting are believed to be frequent side-effects and routine co-administration of metoclopramide is common. In the absence of pre-hospital data to support this practice, we sought to determine the incidence of peri-opiate nausea and vomiting in an ambulance service which does not administer anti-emetics. Methods This prospective observational study is currently assessing the incidence of emesis in 400 patients attended by the North East Ambulance Service, aged above 17 years and receiving morphine, using a patient-scored Nausea and Vomiting Score (NVS: 0=no nausea or vomiting, 1=slight nausea, 2=moderate nausea, 3=severe nausea, 4=vomited once, 5=vomited twice or more). Results To date 145 patients have been recruited. Median NVS before morphine was 0 (range 0 to 6, inter-quartile range (IQR) 0 to 1): 54/141 (38%) of patients had some degree of nausea or vomiting. Median NVS on hospital arrival (after morphine) was 0 (range of 0 to 6, IQR 0 to 1): 54/130 (42%) patients had some degree of nausea or vomiting. The differences pre- vs. post-morphine in median NVS (p=0.98) and proportion of patients suffering nausea and vomiting are not statistically significant (p=0.98 and p=0.54 respectively). There were no significant correlations between pre-morphine pain score and pre-morphine NVS; post-morphine pain score and post-morphine NVS; pre-morphine NVS and total morphine dose; and post-morphine NVS and total morphine dose (Spearman's rank correlation 0.09, p=0.274; 0.07, p=0.44; 0.10, p=0.25; and 0.10, p=0.24 respectively). Conclusion and recommendations To date this study has found no evidence that pre-hospital administration of morphine is associated with an increased incidence or severity of nausea and vomiting and therefore does not appear to support the routine co-administration of metoclopramide. https://emj.bmj.com/content/emermed/28/3/237.2.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/emj.2010.108597.2
    • Smallpox and the origins of vaccination

      McClelland, Graham (2011-05)
      Abstract published with permission. Smallpox is a highly infectious virus with a high mortality rate. Until the 19th century, smallpox epidemics regularly swept the UK. In some areas of the world, smallpox epidemics continued well into the 20th century. Smallpox has now been eradicated by an international effort led by the World Health Organisation (WHO). The eradication of smallpox was achieved by vaccination, and the history of vaccination is closely linked to the treatment of this disease. Despite being eradicated in the natural environment, there are still stocks of smallpox kept by two governments which are the cause of ongoing debate. Today, biological weapons are considered part of the threat posed by terrorist organizations and a deliberate smallpox release is a conceivable scenario. This article will describe smallpox, its connection with vaccination and why knowledge of diseases such as smallpox can be valuable to paramedics.
    • Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): study protocol for a pilot randomised controlled trial

      Shaw, Lisa; Price, Christopher I.M.; McLure, Sally; Howel, Denise; McColl, Elaine; Ford, Gary A. (2011-06)
    • A review of the pre-ROSC intranasal cooling effectiveness study

      Glencorse, Mark; Glencorse, Sandra (2011-06)
      Abstract published with permission. With the publication of the 2010 European Resuscitation Council Guidelines, therapeutic hypothermia has been recommended as part of the treatment algorhythm for the management of adult cardiac arrest. As ambulance services around the world struggle to decide on the best method of cooling a patient at the time of the return of spontaneous circulation (ROSC), the ground-breaking ‘PRINCE’ study has been published describing the novel approach of ‘trans-nasal’ evaporative cooling during the peri-arrest period. This study describes a significant difference found on arrival at hospital between the mean tympanic temperatures of the two groups (cooled vs control) following a period of cooling (34.2 °C [SD 1.5 °C] vs 35.5 °C [SD 0.9 °C], P<0.001). In addition, when looking at survival to discharge following out-of-hospital (OOH) cardiac arrest, there was a statistically significant difference in a subgroup of patients where CPR was commenced within 10 minutes of cardiac arrest (56.5% of trans-nasally cooled patients survived to discharge compared with 29.4% of control patients (P=0.04, relative risk =1.9)). This article examines the PRINCE study and considers the implication of this method of inducing therapeutic hypothermia in the out-of-hospital cardiac arrest patient within the UK.
    • Trauma systems: the anticipated impact of trauma divert in the North East

      Moy, R.; Denning, J.; Han, Kyee (2011-11)
      Introduction The advent of the new Trauma Network system will drive significant changes in the transport of trauma patients. We aimed to find out what the impact of the new trauma network would be on the two prospective trauma centres in the Northern region, in terms of increased workload. This could allow the centres to gain additional resources to provide care for these patients. Methods We conducted a retrospective audit of all trauma patients conveyed by North East Ambulance service during the month of October 2009. These patients were then assessed by the London Ambulance Service Trauma Divert Criteria. Any patients who would have bypassed their local hospital, and been taken to the nearest trauma centre were identified. Also identified were any patients at risk of airway compromise, who would have been transported to the nearest ED for stabilisation and secondary transfer. Patients transported by air ambulance were excluded, as they are already taken to the Trauma Centres. Results 3500 patients were identified during the initial search. Of these, 70 met the criteria for bypass, although 16 were transported to trauma centres as the nearest hospitals. 54 were transported to their nearest hospital, although under the criteria used, would have been taken to a trauma centre. 8 met the criteria for transfer to the nearest hospital, for airway protection. Based on geography of receiving hospital, we estimate that an additional 17 patients would have gone to James Cook University Hospital, and 29 to Newcastle General Hospital. Conclusion We conclude that introduction of the bypass guidelines would lead to an additional 46 patients being taken to a trauma centre in that month. This suggests that specific arrangements may need to be made to deal with the extra workload, and further investment may be required. https://emj.bmj.com/content/emermed/28/11/e2.15.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-2011-200645.8
    • A Retrospective Analysis of the Nature, Extent and Cost of Alcohol-Related Emergency Calls to the Ambulance Service in an English Region

      Martin, N; Newbury-Birch, Dorothy; Duckett, Jay; Mason, H; Shen, J; Shevills, C; Kaner, E (2012-01-18)
    • Lactate measurement in pre-hospital care: a review of the literature

      McClelland, Graham; Younger, Paul; Byers, Sonia (2012-06)
      Abstract published with permission. Background: Lactate has been identified as a useful marker of shock. Lactate can be measured in the pre-hospital environment rapidly and accurately. Method: A comprehensive literature search was conducted using a targeted search strategy. Additional literature was located through reference list searching and prior awareness by the authors. This identified a number of papers which were appraised for relevance. This appraisal identified 29 papers which were included in the review. Conclusion: Lactate has been shown to be measurable in the pre-hospital environment and to be prognostic of mortality. Lactate measurement needs to be linked to specific treatment algorithms with improved outcomes for patients in order to justify inclusion in pre-hospital practice.
    • Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): first results from the pilot randomised controlled trial

      Shaw, L.; Price, C.; McLure, Sally; Howel, Denise; McColl, Elaine; Ford, Gary A. (2012-12)
    • Characteristics of patients according to the mode of admission to regional stroke services

      Price, C.; Rae, V.; Duckett, Jay; Wood, R.; McMeekin, Peter; Gray, J.; Rodgers, Helen; Ford, Gary A. (2012-12)
    • Paramedic consent in the Paramedic Initiated Lisinopril for Acute Stroke Treatment (PIL-FAST) pilot trial

      Shaw, Lisa; Price, Christopher I.M.; McLure, Sally; Howel, Denise; McColl, Elaine; Younger, Paul; Ford, Gary A. (2013-05)
    • A study into pre-alerts to North East hospitals for sepsis

      McClelland, Graham; Younger, Paul (2013-07)
      Abstract published with permission. A study of sepsis patients pre-alerted into hospitals was conducted in the North East of England from October 2011 to March 2013. This study was conducted to assess the effectiveness of the introduction of a sepsis education programme, which included a sepsis screening tool, and to try and establish the number of sepsis cases encountered by paramedics in the region. The results of this study show that the number of cases pre-alerted into the hospitals increased with the introduction of the screening tool, and gave some indications as to the number of sepsis patients encountered in pre-hospital care. We interpret the increase in pre-alerts as an increased awareness of sepsis, but see little impact on the treatment delivered by paramedics. We draw some conclusions on the number of suspected cases of sepsis seen in the pre-hospital environment but without linking to hospital data are unable to give definitive figures.
    • People in rubber suits and how to treat them: decompression injuries in divers

      McClelland, Graham (2013-09-29)
      The majority of our planet is covered in water and millions of people around the world enjoy exploring what lies beneath the surface of our seas and lakes. Diving is a popular activity, with a long history, that allows people to visit—for pleasure or for business—a different world. Diving is a sport with inherent risks. The hazards and potential for injuries, ranging from the minor to the life-threatening, are an unavoidable part of the activity. The factors involved in diving injuries and the signs and symptoms divers may present with, are many and varied. Decompression injuries are one of the potential injuries that will respond to appropriate treatment and may have the longest lasting effects. Confident treatment of decompression injuries is made easier by understanding the physics involved in breathing gases underwater. The definitive treatment involves recompression that should be provided at a specialist hyperbaric facility. Abstract published with permission.
    • An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England

      Price, Christopher I.M.; Rae, Victoria; Duckett, Jay; Wood, Ruth; Gray, Joanne; McMeekin, Peter; Rodgers, Helen; Portas, Karen; Ford, Gary A. (2013-10)
    • The research paramedic: a new role

      McClelland, Graham (2013-10)