• 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)
    • A retrospective observational study to explore the introduction of the National Early Warning Score in NEAS

      McClelland, Graham (2015-02)
      Abstract published with permission. Background: The National Early Warning Score (NEWS) is a simple, rapid assessment tool compiled from respiratory rate, oxygen saturations, supplemental oxygen, temperature, systolic blood pressure, heart rate and level of consciousness developed by the Royal College of Physicians. NEWS was introduced into practice at North East Ambulance Service NHS Foundation Trust (NEAS) between April 2013 and March 2014. This paper will examine the use of NEWS in pre-hospital practice and seek to describe the patient population in terms of NEWS. Methods: Cross-sectional samples of patient records from NEAS attendances over two 24-hour periods were examined for NEWS usage, completeness of necessary observations and outcomes that may be linked to NEWS. A primary sample from 8 July 2013 included 100% of patients. A secondary sample of 10% of patients was taken from 1 April 2014. Results: Although 90% of all cases may be suitable for NEWS <1% (n=6) of patients attended had NEWS recorded. Of the NEWS elements only temperature was not consistently recorded. 95% of sets of observations included >4 NEWS elements. A consistent pattern emerged when the sample population was described according to NEWS using three methods of accounting for missing items of data. Pre-alerting based on NEWS was examined with little agreement between NEWS and current practice found, although this does not take into account practical reasons for pre-alerting such as underlying condition or local pathways. Conclusions: NEWS is not being documented by ambulance crews although the majority of the necessary elements are being recorded. This largely descriptive account of the use of NEWS within NEAS indicates that NEWS has not been adopted by ambulance crews.
    • A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

      Flynn, Darren; Francis, Richard; Robalino, Shannon; Lally, Joanne; Snooks, Helen; Rodgers, Helen; McClelland, Graham; Ford, Gary A.; Price, Christopher (2017-02)
    • 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.
    • A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke

      Lumley, H.A.; Flynn, Darren; Shaw, L.; McClelland, Graham; Ford, Gary A.; White, P.M.; Price, Christopher (2020-04-26)
    • 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.
    • A service evaluation of the iTClamp™50 in pre-hospital external haemorrhage control

      Shaw, Gary; Thompson, Lee; Davies, Caroline (2016-09)
      Abstract published with permission. It has long been accepted that uncontrolled haemorrhage is a leading cause of early death in trauma patients, with the majority of deaths occurring in the pre-hospital setting. While most cases of haemorrhage can be dealt with using standard dressings, tourniquets and haemostatic agents, some anatomical areas such as the head, neck, axilla and junctional areas continue to be problematic, as it is challenging to apply tourniquets or trauma pressure dressings to these areas effectively. One device designed to overcome this issue is the iTClamp™50, which was the subject of a service evaluation by the North East Ambulance Service NHS Foundation Trust, from July 2014 to February 2016. Experienced paramedics stationed close to the participating major trauma centre were asked to evaluate the device with a view to obtaining a minimum of 20 cases of iTClamp use to determine its suitability. Paramedic participants were trained by the manufacturer before being provided with two iTClamps. After every application, the evaluating paramedic produced an unstructured reflective account and completed an evaluation questionnaire. Paramedics who used the iTClamp™50 found it enhanced their ability to quickly control external haemorrhage in difficult anatomical areas and could be used as part of a major haemorrhage control strategy. Overall, paramedics felt it was quick and easy to use following a short training session.
    • 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.
    • Stakeholder engagement in the design of a novel pre-hospital acute stroke assessment

      Lally, Joanne; McClelland, Graham; Exley, Catherine; Ford, Gary A.; Price, Christopher (2016-09)
      Background Outcomes for stroke patients can be improved by rapid identification and assessment, but delays commonly occur due to the availability of clinical information and brain imaging. We sought to develop a novel paramedic-led intervention to reduce scene to needle time for stroke patients suitable for thrombolysis. Methods Over 12 months we undertook group interviews and consultation in North East England, North West England and Wales involving patient representatives (n=20), paramedics, emergency department and stroke service hospital staff (n=100). The primary aim was to understand the impact of organisational boundaries, service pressures and traditional professional roles upon a new paramedic approach to stroke assessment. Secondly, to develop a clinical trial protocol for later evaluation of the proposed new paramedic approach. All interviews were digitally recorded, transcribed and analysed using open then focussed coding. Results Participant feedback supported an intervention which transgressed organisational and professional boundaries. Modifications were made following participant views about logistical, ethical and governance issues: ▸ The protocol was changed to reflect operational barriers restricting paramedics taking patients directly to the CT scan room. ▸ Participants advocated obtaining research consent after admission in order to address concerns over treatment delays, and supported a trial protocol which allowed data collection from patients that died before consent was feasible. ▸ Paramedics would provide additional information at patient handover directly to the stroke team or A&E staff rather than attempt to convey more during pre-notification. Conclusions Following the interviews significant alterations were made to the intervention and protocol in order to improve trial feasibility, acceptability and data quality. This emphasizes the importance of engaging with ambulance services, other clinical teams and patients during the development of pre-hospital research protocols. https://emj.bmj.com/content/emermed/33/9/e9.3.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-2016-206139.31
    • Storytelling via social media in the ambulance services

      Cotton, Mark; MacGregor, Murray; Warner, Claire; Bateson, Fiona (2019-09-11)
    • 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.
    • A survey of paramedic advanced airway practice in the UK

      Younger, Paul; Pilbery, Richard; Lethbridge, Kris (2016-12)
      Abstract published with permission. Introduction ‐ Although there are published studies examining UK paramedic airway management in the out-of-hospital setting, there has been no sizeable survey of practicing UK paramedics that examines their advanced airway management practice, training and confidence. Therefore, the Airway Management Group of the College of Paramedics commissioned a survey to gain an up to date snapshot of advanced airway management practice across the UK among paramedics. Methods ‐ An online questionnaire was created, and a convenience sample of Health and Care Professions Council (HCPC) registered paramedics was invited to participate in the survey. Invitations were made using the College of Paramedics e-mail mailing list, the College website, as well as social media services such as Twitter and Facebook. The survey ran online for 28 days from 21 October to 18 November 2014 to allow as many paramedics to participate as possible. The survey questions considered a range of topics including which supraglottic airway devices are most commonly available in practice and whether or not tracheal intubation also formed a part of individual skillsets. In relation to intubation, respondents were asked a range of questions including which education programmes had been used for original skill acquisition, how skills were maintained, what techniques and equipment were available for intubation attempts, individual practitioner confidence in intubation and how intubation attempts were documented. Results ‐ A total of 1658 responses to the survey were received. Following data cleansing, 152 respondents were removed from the survey, leaving a total of 1506. This represented 7.3% of paramedics registered with the HCPC (20,565) at the time the survey was conducted. The majority of respondents were employed within NHS ambulance services. Summary ‐ This is the largest survey of UK paramedics conducted to date, in relation to advanced airway management. It provides an overview of advanced airway management, with a particular focus on intubation, being conducted by UK paramedics.
    • A survey of pre-hospital stroke pathways used by UK ambulance services

      McClelland, Graham; Rodgers, Helen; Price, Christopher (2018-12)
    • A survey of UK paramedics' views about their stroke training, current practice and the identification of stroke mimics

      McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher (2017-06)
      Abstract published with permission. Aims ‐ Paramedics play a crucial role in identifying patients with suspected stroke and transporting them to appropriate acute care. Between 25% and 50% of suspected stroke patients are later diagnosed with a condition other than stroke known as a ‘stroke mimic’. If stroke mimics could be identified in the pre-hospital setting, unnecessary admissions to stroke units could potentially be avoided. This survey describes UK paramedics’ stroke training and practice, their knowledge about stroke mimic conditions and their thoughts about pre-hospital identification of these patients. Methods ‐ An online survey invitation was circulated to members within the UK College of Paramedics and promoted through social media (8 September 2016 and 23 October 2016). Topics included: stroke training; assessment of patients with suspected stroke; local practice; and knowledge about and identification of stroke mimics. Results ‐ There were 271 responses. Blank responses (39) and non-paramedic (1) responses were removed, leaving 231 responses from paramedics which equates to 2% of College of Paramedics membership and 1% of Health and Care Professions Council registered paramedics. The majority of respondents (78%) thought that they would benefit from more training on pre-hospital stroke care. Narrative comments focused on a desire to improve the assessment of suspected stroke patients and increase respondents’ knowledge about atypical stroke presentations and current stroke research. The Face Arm Speech Test was used by 97% of respondents to assess suspected stroke patients, although other tools such as Recognition of Stroke in the Emergency Room (17%) and Miami Emergency Neurological Deficit (11%) were also used. According to those responding, 50% of stroke patients were taken to emergency departments, 35% went straight to a stroke ward and 8% were taken directly to CT scan. Most respondents (65%) were aware of the term ‘stroke mimic’. Two-thirds of respondents (65%) thought a tool that predicted the likelihood of a suspected stroke being a stroke mimic would be useful in pre-hospital care. Conclusion ‐ This study reports a survey of UK paramedics’ views about the stroke care they provide. Conclusions are limited by the low number of responses. Assessment of suspected stroke patients was recognised as an important skill by paramedics and an area where many would like further training. Respondents’ current practice varied in terms of the stroke assessment tools used and whether suspected stroke patients were taken to the emergency department or direct to a stroke ward. A stroke mimic identification tool would be useful if it allowed stroke mimic patients to be directed to appropriate care, but it would need to have a high level of specificity and not adversely impact on time to treatment for true stroke patients.
    • A systematic review of the clinical and demographic characteristics of adult patients with stroke mimics

      McClelland, Graham; Flynn, Darren; Rodgers, Helen; Price, Christopher (2015-09-01)