• Paramedic perceptions and attitudes to working with patients with alcohol related injury or illness

      Glencorse, Mark; Wilson, Graeme; Newbury Birch, Dorothy (2014-06)
      Abstract published with permission. Aims: To ascertain views, perceptions and attitudes of paramedics when working with patients presenting with alcohol-related injury or illness, and to explore perceived barriers and facilitators for the introduction of alcohol interventions to the NHS ambulance services. Methods: A total of 142 (24%) from 589 paramedics from the North East Ambulance Service NHS Foundation Trust returned completed surveys between January 2013 to April 2013, which included measures of current perceptions and attitudes of working with patients with alcohol-related injury or illness, and the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Results: Paramedics reported little to no formal training on working with patients with alcohol-related injury or illness (77%). Paramedics scored low across all domains of the SAAPPQ for working with both problem and dependent drinkers. Not having suitable counseling materials (77%), not enough training (72%) and no facilities or time to deal with prevention (69%) were key barriers. Conclusions: At this present time, levels of commitment, motivation, satisfaction, legitimacy and adequacy are low in front-line paramedics when working with patients with alcohol-related injury and illness. However, they are open to finding ways to provide interventions if they are adequately trained and have appropriate referral pathways open to them.
    • Paramedic training by online video increases the availability of information for hyperacute stroke treatment decisions

      Rudd, M.; Ford, Gary A.; Flynn, Darren; McClelland, Graham; Price, Christopher (2015-12)
    • 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.
    • Phenomenological study exploring ethics in prehospital research from the paramedic's perspective: experiences from the Paramedic-2 trial in a UK ambulance service

      Charlton, Karl; Franklin, John; McNaughton, Rebekah (2019-09)
      Objectives We set out to investigate paramedics’ views of ethics and research, drawing on experiences from Paramedic-2, a randomised controlled trial comparing epinephrine and placebo in out-of-hospital cardiac arrest (OHCA). Methods An interpretative phenomenological approach was adopted. A purposive sample of paramedics (n=6) from North East Ambulance Service NHS Foundation Trust were invited to a semi-structured, in-depth interview. Results Three superordinate themes emerged: (1) morality, (2) emotion and (3) equipoise. Some viewed Paramedic-2 as an opportunity to improve OHCA outcomes for the many, viewing participation as a moral obligation; others viewed the study as unethical, equating participation with immoral behaviour. Morality was a motivator to drive individual action. Positive and negative emotions were exhibited by the paramedics involved reflecting the wider view each paramedic held about trial participation. Those morally driven to participate in Paramedic-2 discussed their pride in being associated with the trial, while those who found participation unethical, discussed feelings of guilt and regret. Individual experience and perceptions of epinephrine guided each paramedic’s willingness to accept or reject equipoise. Some questioned the role of epinephrine in OHCA; others believed withholding epinephrine was synonymous to denying patient care. Conclusion A paucity of evidence exists to support any beneficial role of epinephrine in OHCA. Despite this, some paramedics were reluctant to participate in Paramedic-2 and relied on their personal perceptions and experiences of epinephrine to guide their decision regarding participation. Failure to acknowledge the importance of individual perspectives may jeopardise the success of future out-of-hospital trials. https://emj.bmj.com/content/36/9/535.long 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 eg http://dx.doi.org/10.1136/emermed-2019-208556
    • A pilot study exploring the accuracy of pre-hospital sepsis recognition in the North East Ambulance Service

      McClelland, Graham; Jones, Jacqui (2015-09)
      Abstract published with permission. Background: Over the past decade there has been a focus on improving pre-hospital recognition and treatment of patients with sepsis. This pilot study investigates pre-hospital sepsis recognition, including the use of a Sepsis Screening Tool (SST), treatment and whether timely identification influenced the time to treatment and outcome at the receiving unit. Methods: A cross-sectional sample of patients with a documented suspicion of sepsis by North East Ambulance Service NHS Foundation Trust (NEAS) was combined and cross referenced with patients coded for sepsis at The James Cook University Hospital (JCUH) to generate a sample of sepsis patients seen within January 2014. NEAS sepsis recognition was compared with SST identification by retrospectively examining patients’ medical records. Sensitivity and specificity for NEAS diagnosis were calculated by comparing NEAS identification with JCUH diagnosis using the hospital SST. Results: The sample included 49 patients from January 2014. NEAS correctly identified 18/42 patients with sepsis (43% sensitivity, 14% specificity). NEAS correctly identified 8/27 patients with severe sepsis (30% sensitivity, 77% specificity). Conclusions: It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Use of the SST would improve the ability of NEAS clinicians to identify patients with sepsis.
    • Positive predictive value of stroke identification by ambulance clinicians in North East England: a service evaluation

      McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher (2020-05-08)
      Accurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England. https://emj.bmj.com/content/37/8/474. 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/ https://https://emj.bmj.com/content/37/8/474
    • Positive Predictive Value of Stroke Identification by Ambulance Clinicians in North East England: A Service Evaluation

      McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher (2020-05-08)
      Introduction/background Accurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England. Methods This service evaluation linked routinely collected records from a UK regional ambulance service identifying adults with any clinical impression of suspected stroke to diagnostic data from four National Health Service hospital trusts between 1 June 2013 and 31 May 2016. The reference standard for a confirmed stroke diagnosis was inclusion in Sentinel Stroke National Audit Programme data or a hospital diagnosis of stroke or transient ischaemic attack in Hospital Episode Statistics. PPV was calculated as a measure of diagnostic accuracy. Results Ambulance clinicians in North East England identified 5645 patients who had a suspected stroke (mean age 73.2 years, 48% male). At least one Face Arm Speech Test (FAST) symptom was documented for 93% of patients who had a suspected stroke but a positive FAST was only documented for 51%. Stroke, or transient ischaemic attack, was the final diagnosis for 3483 (62%) patients. SM (false positives) accounted for 38% of suspected strokes identified by ambulance clinicians and included a wide range of non-stroke diagnoses including infections, seizures and migraine. Discussion In this large multisite data set, identification of patients who had a stroke by ambulance clinicians had a PPV rate of 62% (95% CI 61 to 63). Most patients who had a suspected stroke had at least one FAST symptom, but failure to document a complete test was common. Training for stroke identification and SM rates need to be considered when planning service provision and capacity. http://dx.doi.org/10.1136/emermed-2019-208902. 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/
    • Post-admission outcomes of participants in the PARAMEDIC trial: a cluster randomised trial of mechanical or manual chest compressions

      Ji, Chen; Lall, Ranjit; Quinn, Tom; Kaye, Charlotte; Haywood, K.; Horton, Jessica; Gordon, V.; Deakin, Charles D.; Pocock, Helen; Carson, Andrew; et al. (2017-09)
    • Pre-hospital lactate monitoring for adults with sepsis

      Charlton, Karl (2014-09)
      Abstract published with permission. Background: Sepsis is a life-threatening condition that claims 37 000 lives in the UK. The sepsis six care bundle was developed by the surviving sepsis campaign in 2002 to address this high mortality rate. Part of this care bundle involves measuring blood lactate which is prognostic of mortality. Lactate can be measured by paramedics in the pre-hospital setting using hand held monitors similar to blood glucose machines, with accuracy that is comparable to laboratory measured lactate. Method: A focused electronic literature search was carried out on a number of different databases as well as a hand search of specific relevant journals. Data was also obtained from reference harvesting, although the limitations of this was appreciated. Experts in the field were also contacted with relevant data obtained. An ongoing pre-hospital trial monitoring lactate was also identified and these researchers were contacted with relevant data obtained. Conclusions: Pre-hospital lactate monitoring would promote better recognition of sepsis in adults and improve the quality of care. It could be used to initiate a specific treatment regime such as intravenous antibiotics. This would reduce the numbers of patients admitted to intensive care, helping to reduce mortality and costs for the NHS.
    • Prehospital adrenaline administration for out-of-hospital cardiac arrest: the picture in England and Wales

      Booth, Scott; Ji, Chen; Soar, Jasmeet; Siriwardena, Aloysius; Fothergill, Rachael; Spaight, Robert; Perkins, Gavin D. (2018-09)
    • Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

      Gates, Simon; Lall, Ranjit; Quinn, Tom; Deakin, Charles D.; Cooke, Matthew W.; Horton, Jessica; Lamb, Sarah E.; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andrew; et al. (2017-04)
    • 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 randomized trial of epinephrine in out-of-hospital cardiac arrest

      Perkins, Gavin D.; Ji, Chen; Deakin, Charles D.; Quinn, Tom; Nolan, Jerry P.; Scomparin, Charlotte; Regan, Scott; Long, John; Slowther, Anne-Marie; Pocock, Helen; et al. (2018-08)
    • 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
    • Regionalised cardiac arrest centres as a means to improve outcomes from out-of-hospital cardiac arrest in the UK: a literature review

      Miles, Steven (2016-12)
      Abstract published with permission. Introduction ‐ Sudden (out-of-hospital) cardiac arrest (OHCA) is recognised as a leading cause of death in the UK; however, survival rates remain significantly lower in the UK than in other developed countries such as Norway and Holland, which have specialised regional cardiac arrest systems and centres. Aims ‐ This review aims to look at the concept and potential benefits of specialised regional cardiac arrest centres, and to consider whether development of such centres, with bypass protocols to enable transportation of OHCA patients directly to these centres, could improve survival rates and patient outcomes in the UK. Methods ‐ Literature was identified through searching MEDLINE, ProQuest Central, CINAHL and PubMed Central databases, as well as relevant national websites, with the search terms ‘cardiac arrest’, ‘regionalised care’ and ‘out-of-hospital cardiac arrest’. Further screening used the inclusion criteria of publication within the previous 10 years (2006‐2016), English language and peer reviewed journals. Exclusion criteria included duplicated articles, articles with a primary focus on in-hospital arrests and focus on causes and prevention of cardiac arrest. Forty-three records resulted and their full texts were considered and reviewed individually to identify those supported by other sources and containing information to add to understanding of the topic Results ‐ A range of evidence is found to support the development of specialised regional cardiac arrest centres, with bypass protocols to enable ambulance staff to transport directly to these centres. Essential facilities for cardiac arrest centres are identified and potential barriers to development of these centres are discussed. Utilisation of paramedics with additional equipment and skills is considered to enable direct admissions to regional cardiac arrest centres to be effective. Conclusions ‐ Cardiac arrest centres, alongside bypass protocols to enable direct admission, could improve patient outcomes and survival rates for OHCA in the UK. For these measures to be effective some barriers to change need to be addressed and paramedics with additional skills and equipment used. Evidence from within the UK itself appears limited. Further research is needed within the UK, involving a multidisciplinary approach, with close working partnership between hospitals and the ambulance service in relation to development of regional cardiac arrest centres.
    • Report from the first pre-hospital sepsis conference

      McClelland, Graham; Younger, Paul (2014-07)
    • Research developments within the Allied Health Professions Research Network (AHPRN)

      Williams, Julia; Robinson, Maria; McClelland, Graham (2014-01)
    • The research paramedic: a new role

      McClelland, Graham (2013-10)
    • 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)