Recent Submissions

  • Mass casualty triage : using virtual reality in hazardous area response teams training

    Thompson, Steven (2023-09-12)
    Background: In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training. Aims: The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI. Methods: The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.Background: In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training. Aims: The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI. Methods: The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.
  • Trends in use of intraosseous and intravenous access in out-of-hospital cardiac arrest across English ambulance services: a registry-based, cohort study

    Vadeyar, Sharvari; Buckle, Alexandra; Hooper, Amy; Booth, Scott; Deakin, Charles; Fothergill, Rachael; Chen, Ji; Nolan, Jerry P; Brown, Martina; Cowley, Alan; et al. (2023-10)
  • Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections

    Fahmi, Ali; Palin, Victoria; Zhong, Xiaomin; Yang, Ya-Ting; Watts, Simon; Ashcroft, Darren; Goldacre, Ben; MacKenna, Brian; Fisher, Louis; Massey, Jon; et al. (2023-07-18)
  • Carrying out research, critical appraisal, ethics and stakeholder involvement

    Rees, Scott (2023-11-02)
    Research skills are a requirement under the Health and Care Professions Council (HCPC) standards for paramedic registration. Paramedics must ‘recognise the value of research to the critical evaluation of practice’. Research in the medical field is important in order to improve the knowledge of clinicians and inform evidence-based practice. The purpose of this article is to demonstrate the key components of the research process, use of a PICO [population, intervention, comparison, outcome] tool to search relevant databases and explain the critical appraisal of research in order to establish if research is valid before implementing results into paramedic practice. Abstract published with permission.
  • Determining current approaches to the evaluation of the quality of healthcare simulation-based education provision: a scoping review

    Pogson, Rachel; Henderson, Helen; Holland, Matt; Sumera, Agnieszka; Sumera, Kacper; Webster, Carl (2023-10-05)
  • Improving paramedic responses for patients dying at home: a theory of change-based approach

    Simpson, Jane; Remawi, Bader Nael; Potts, Kieran; Blackmore, Tania; French, Maddy; Haydock, Karen; Peters, Richard; Hill, Michael; Tidball, Oliver-Jon; Parker, Georgina; et al. (2023-08-02)
  • A step toward enhanced EMS telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified

    Alotaibi, Ahmed; Body, Richard; Carley, Simon; Pennington, Elspeth (2022-08-23)
    Abstract Background Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls. Methods We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at ≥ 70%. Results A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation <90%, heart rate <40/minute or systolic blood pressure <90mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response. Conclusion Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain. https://emj.bmj.com/content/39/9/e5.6 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/openhrt-2015-000281
  • Clinical ECGs in paramedic practice

    Romano, Vincent (MA Healthcare, 2023-03-02)
  • Peer support after exposure to trauma: an evaluation

    Romano, Vincent (2023-07-02)
    Background: There are various staff wellbeing programmes used across the emergency services. The British Military recognised single-session models were not effective and developed Trauma Risk Management (TRiM). A number of organisations now use TRiM as a peer-led traumatic stress support system, including the North West Ambulance Service. Aims: This evaluation aimed to identify engagement with TRiM across the North West Ambulance Service. Method: A combination of quantitative and qualitative data was analysed from those who engaged with TRiM. Findings: There was a perception that road traffic collision (RTC) and cardiac arrests would cause acute stress symptoms and require a TRiM assessment; this was validated by the uptake of assessments and referral to professional counselling following such incidents. Conclusion: TRiM can provide effective peer-delivered support across a large geographical workforce. Implementation and coordination are key to ensuring success. Abstract published with permission.
  • Neurological assessment with FAST to better detect posterior circulation stroke

    Godley, Nicola (2023-07-02)
    Posterior circulation stroke (PCS) represents up to 25% of ischaemic strokes and affects more than 20000 people annually within the UK. Prehospital clinical practice guidelines recommend the use of a validated stroke screening tool, such as the ‘Face, Arms, Speech, Time’ [FAST] tool for the assessment of all patients presenting with stroke symptoms. However, with PCS, patients may present with vestibular symptoms, which cannot be detected with ‘FAST’. Furthermore, over one-third of patients with PCS are delayed or misdiagnosed due to a lack of apparent ‘typical’ acute stroke symptoms. The ‘FAST’ tool is deemed to have high sensitivity and moderate specificity in the recognition of ischaemic stroke; yet there is evidence within the literature determining that the ‘FAST’ tool is not adequate for prehospital screening of PCS, leading to misdiagnosis, treatment delay, and severe life-limiting deficits or death. The aim of this literature search is to evaluate how the use of additional neurological assessment, alongside the validated ‘FAST’ tool, could be used within the prehospital setting for the improved paramedic detection of PCS. Abstract published with permission.
  • Hospital handover improvements

    Gibbs, Emily; Dunn, Lynsey; Hargreaves, Caroline (2023-07-16)
  • Video vs direct laryngoscopy for adults undergoing endotracheal intubation

    Bell, Steve; Pennington, Elspeth; Hill, James E. (2023-06-02)
    The safety and utility of endotracheal intubation by paramedics in the UK is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess and compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice. Abstract published with permission
  • Diagnostic accuracy of clinical pathways for suspected acute myocardial infarction in the out-of-hospital environment

    Alghamdi, Abdulrhman; Hann, Mark; Carlton, Edward; Cooper, Jamie G.; Cook, Eloïse; Foulkes, Angela; Siriwardena, Aloysius; Phillips, John; Thompson, Alexander; Bell, Steve; et al. (2023-06-10)
  • Apps for paramedics

    Romano, Vincent (2023-05-02)
    JRCALC App - The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines are often referred to as the prehospital ‘Bible’. They have been the ‘go to’ guidelines for all UK NHS Ambulance services since 2019, although were first created in the early 2000s, with three annual updates produced since 2013. For those that were in practice in the late noughties, you will recall carrying around a well-weathered JRCALC pocketbook which would be pulled out prior to administration of medications or to check an algorithm. The application (app) is essentially the full guidelines accessed through a reasonably easy to-use app. Abstract published with permission.
  • Demystifying prehospital research in practice

    Wilson, Caitlin (2023-05-02)
    It is not every day you are asked to review a book written by esteemed colleagues and friends—but here I am. In this month's book review, I am reviewing Prehospital Research Methods and Practice, edited by Professor Niro Siriwardena and Dr Greg Whitley. The two editors are of course well-known experts in prehospital research, with the list of authors including paramedic researchers and experienced academics mainly from across the UK, but also including colleagues from Australia and the United States. Abstract published with permission.
  • External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting

    Alotaibi, Ahmed; Abdulrhman, Alghamdi; Martin, Glen P.; Carlton, Edward; Cooper, Jamie G.; Cook, Eloise; Siriwardena, Aloysius; Phillips, John; Thompson, Alexander; Bell, Steve; et al. (2023-04-17)
    ABSTRACT Objectives The Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in the emergency department (ED), but its accuracy in the pre-hospital setting is unknown. We aimed to externally validate MACS-ECG in the pre-hospital environment. Methods We undertook a secondary analysis from the Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study, a multi-centre prospective study to validate decision aids in the pre-hospital setting (26 February 2019 to 23 March 2020). Patients with chest pain where the treating paramedic suspected acute coronary syndrome were included. Paramedics collected demographic and historical data and interpreted ECGs contemporaneously (as ’normal’ or ’abnormal’). After completing recruitment, we analysed ECGs to calculate the MACS-ECG score, using both a pre-defined threshold and a novel threshold that optimises sensitivity to differentiate AMI from non-AMI. This was compared with subjective ECG interpretation by paramedics. The diagnosis of AMI was adjudicated by two investigators based on serial troponin testing in hospital. Results Of 691 participants, 87 had type 1 AMI and 687 had complete data for paramedic ECG interpretation. The MACS-ECG model had a C-index of 0.68 (95% CI: 0.61 to 0.75). At the pre-determined cut-off, MACS-ECG had 2.3% (95% CI: 0.3% to 8.1%) sensitivity, 99.5% (95% CI: 98.6% to 99.9%) specificity, 40.0% (95% CI: 10.2% to 79.3%) positive predictive value (PPV) and 87.6% (87.3% to 88.0%) negative predictive value (NPV). At the optimal threshold for sensitivity, MACS-ECG had 50.6% sensitivity (39.6% to 61.5%), 83.1% specificity (79.9% to 86.0%), 30.1% PPV (24.7% to 36.2%) and 92.1% NPV (90.4% to 93.5%). In comparison, paramedics had a sensitivity of 71.3% (95% CI: 60.8% to 80.5%) with 53.8% (95% CI: 53.8% to 61.8%) specificity, 19.7% (17.2% to 22.45%) PPV and 93.3% (90.8% to 95.1%) NPV. Conclusion Neither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to ’rule in’ or ’rule out’ NSTEMI alone. https://emj.bmj.com/content/early/2023/04/17/emermed-2022-212872 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/openhrt-2015-000281
  • Identity, positionality and reflexivity: relevance and application to research paramedics

    Wilson, Caitlin; Janes, Gillian; Williams, Julia (The College of Paramedics, 2022-09-01)
    This article introduces the reader to the concepts of identity, positionality and reflexivity and outlines their relevance to research paramedics. We outline how a researcher’s identity and positionality can influence all aspects of research, including the research question, study design, data collection and data analysis. We discuss that the ‘insider’ position of paramedics conducting research with other paramedics or within their specific clinical setting has considerable benefits to participant access, understanding of data and dissemination, while highlighting the difficulties of role duality and power dynamics. While positionality is concerned with the researcher clearly stating their assumptions relating to the research topic, the research design, context and process, as well as the research participants; reflexivity involves the researcher questioning their assumptions and finding strategies to address these. The researcher must reflect upon the way the research is carried out and explain to the reader how they moved through the research processes to reach certain conclusions, with the aim of producing a trustworthy and honest account of the research. Throughout this article, we provide examples of how these concepts have been considered and applied by a research paramedic while conducting their PhD research studies within a pre-hospital setting, to illustrate how they can be applied practically. Abstract published with permission.

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