Recent Submissions

  • Where to look: sources of research in paramedicine

    Holland, Matt; Dutton, Michelle; Glover, Steve (2021-08)
    This article explains how to approach searching for paramedicine research, and the order in which you should consider types of sources, from synthesised sources to individual studies. Databases and sources for literature are covered and common issues about the search process are addressed, including when a search is complete and finding a gap in the literature. https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2021.13.8.316 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 http://dx.doi.org/10.12968/jpar.2021.13.8.316
  • Prehospital triage tools in major trauma: a critical appraisal of a systematic review

    Bell, Steve; Hill, James E (2022-09-02)
    Effective triage is critical to ensure patients suffering major trauma are identified and access a pathway to definitive major trauma care, which is typically provided in a major trauma centre as part of an established major trauma system. The prehospital triage of trauma patients often relies upon the use of major trauma triage tools; this commentary critically appraises a recent systematic review that sought to evaluate and compare the accuracy of prehospital triage tools for major trauma. Abstract published with permission.
  • Mental health care in paramedic practice

    Romano, Vincent (2022-09-02)
    If you are a frontline clinician within an ambulance service, you will be fully aware that mental health incidents are commonplace, complex, time consuming and, at times, frustrating for both patient and clinician. The traditional training that paramedics and technicians undergo will include mental health conditions; however, the proportion of incidents attended compared to the time afforded to this topic do not equate. I can confidently say that a Paramedic BSc programme will spend considerably more time covering trauma management and cardiac arrest than how to take a comprehensive mental health history, formulate a safe plan and accept a refusal from a patient that has self-harmed and will not go to hospital. Abstract published with permission
  • Paramedic pharmacology: more than facts and dosages

    Wilson, Caitlin (2022-08-02)
    As someone who recalls agonisingly learning JRCALC drug dosages, cautions and (contra-) indications off by heart during my undergraduate paramedic degree, I was not particularly looking forward to the idea of reviewing a pharmacology book. However, the introductory paragraphs of Pharmacology for Paramedics seemed like they were written for someone just like me and put my worries at ease. The authors start off with a detailed case study and draw the reader in to actively consider the appropriate clinical decisions and treatment plan by asking poignant questions. However, they then ask the reader not to approach pharmacology as a topic that requires memorisation of a multitude of facts and dosages— but rather to view it as an opportunity to synthesise and apply all prior learning on anatomy and physiology, as well as disease management. They ask the reader to stop and reflect upon how they would apply what they are reading in a patient encounter. Now that sounds far more interesting and relevant than learning things off by heart! Compliments to the authors for getting me to open my mind to this topic—if nothing else, I have a slightly more positive view of pharmacology. Abstract published with permission.
  • Prehospital airway management

    Bell, Steve; Pennington, Elspeth; Hill, James; Harrison, Joanna (2022-02-02)
    The prehospital emergency airway management is a key moderating factor for patient survival and mortality rates. There has been much debate around the optimum method of prehospital emergency airway management. This commentary critically appraises a recent systematic review which assesses the harms and benefits of three different airway management strategies for a range of emergency clinical scenarios. Abstract published with permission.
  • The diagnostic accuracy of prehospital triage tools in identifying patients with traumatic brain injury: A systematic review

    Alqurashi, Naif; Alotaibi, Ahmed; Bell, Steve; Lecky, Fiona; Body, Richard (2022-06-01)
  • Prevalence, severity and preventability of prehospital patient safety incidents

    Pennington, Elspeth; Price, Jon; Bell, Steve; Hill, James (2022-07-02)
    The provision of safe and effective healthcare is a mainstay for all services and clinicians associated with the delivery of prehospital care; however, little is empirically known about the prevalence and impact of harm caused in the prehospital phase. This commentary critically appraises a recent systematic review which sought to identify the frequency of patient safety incidents and the harm associated with them in prehospital care. Abstract published with permission.
  • Celebrating International Women's Day: where does this leave the paramedic profession?

    Wilson, Caitlin; Prothero, Larissa Stella; Williams, Julia (The College of Paramedics, 2022-03)
  • An atypical presentation of orthostatic hypotension and falls in an older adult

    Thoburn, Steve; Cremin, Steve; Holland, Mark (The College of Paramedics, 2022-03)
    Introduction: Falls are a significant cause of morbidity and mortality in older adults. Orthostatic hypotension (OH) is very common in this cohort of patients and is a significant risk for falls and associated injuries. We present the case of an 89-year-old female who fell at home, witnessed by her husband. OH was identified during the clinical assessment and considered to be the predominant contributing factor, although the clinical presentation was not associated with classical symptoms. Case presentation: The patient lost balance while turning away from the kitchen sink; she noted some instability due to a complaint of generalised weakness in both of her legs. No acute medical illness or traumatic injury was identified. A comprehensive history was obtained that identified multiple intrinsic and extrinsic risk factors for falling. The cardiovascular examination was unremarkable except for OH, with a pronounced reduction in systolic blood pressure of 34 mmHg at the three-minute interval and which reproduced some generalised weaknesses in the patient's legs and slight instability. Although classical OH symptoms were not identified, this was considered to be the predominant factor contributing to the fall. A series of recommendations was made to primary and community-based care teams based upon a rapid holistic review; this included a recommendation to review the patient's dual antihypertensive therapy. Conclusion: It is widely known that OH is a significant risk factor for falls, but asymptomatic or atypical presentations can make diagnosis challenging. Using the correct technique to measure a lying and standing blood pressure, as defined by the Royal College of Physicians, is crucial for accurate diagnosis and subsequent management. Ambulance clinicians are ideally placed to undertake this quick and non-invasive assessment to identify OH in patients that have fallen. Abstract published with permission.
  • What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

    Hetherington, Jeff; Jones, Ian (2021-06-01)
    Background: Children’s healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community. Aim: This study looked to understand the lived experiences of paramedics when attending to paediatric patients, and what factors influenced decision making. Methods: A qualitative study employing semi-structured interviews, to collect and describe the lived experiences of participants. Participants were paramedics working for an ambulance service responding to calls in the community. Participants varied in experience and registrant level of education. Interview data were transcribed verbatim and analysed utilising inductive thematic analysis. Results: Education provoked the most discussion, with a desire for more knowledge and training to improve confidence when attending to patients with low acuity complaints. Confidence was found to be intrinsically linked to experience, with clinicians who were more exposed to paediatrics in their professional or personal life displaying more confidence when attending to this patient group. Emotion of clinicians and/or families contributes to the clinical decision-making process; coupled with a reliance on clinical guidelines, there is a high probability of a paediatric consultation resulting in conveyance to an emergency department. Provision of care was variable geographically, with largely negative experiences observed with attempts for community referrals. Conclusions: Providing a focus of education more reflective of paramedics’ experiences will address some of the factors discussed by participants. Introducing innovative solutions such as developing guidelines for lower acuity conditions and the introduction of specialist roles could contribute to mitigating the barriers paramedics faced while improving the quality of care provided to paediatric patients. Barriers to confidence existing due to lack of exposure may well still exist, as would options to refer to community services. Abstract published with permission.
  • The effectiveness and safety of paediatric prehospital pain management: a systematic review

    Abebe, Yonas; Hetmann, Fredrik; Sumera, Kacpar; Holland, Matt; Staff, Trine (2021-12-11)
  • Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital

    Rollinson, Thomas J.; Furnival, Joy; Goldberg, Sarah; Choudhury, Aklak (2021-11-25)
    A Lean-based improvement approach was used to complete a quality improvement project (QIP) focused on improving speed and quality of discharge of frail patients on two wards at a large teaching hospital in the UK. This was part of a national initiative to embed continuous improvement within the trust. The aim of the QIP was to improve the proportion of prenoon discharges to 33% of total patients discharged from the ward each day. An ‘improvement practice process’ followed, which included seven discrete workshops that took the QIP through four distinct phases—understand, design, deliver and sustain. Several improvement methods and tools were used, including value stream mapping and plan–do–study–act (PDSA) cycles. Ten PDSA cycles were implemented across the clinical areas, including improved planning and data collection of discharge, improved communication between nursing and medical staff, and earlier referrals to community hospitals for discharge. Improved performance was identified through the outcome metric prenoon discharges on both wards, with the average increasing from 8% to 24% on ward X and from 9% to 19% on ward Y, with no other significant change seen in other measures. Pettigrew et al’s context–content–process change model was used to structure the learning from the QIP, which included the impact of varying ward contexts, the format of conducting improvement with staff, the importance of organisational support, the need for qualitative measures, agreeing to an apposite aim and the power of involving service users. The original aim of 33% prenoon discharges was not achieved, yet there was clear learning from completing the QIP which could contribute to ongoing improvement work. This identified that the Lean-based improvement approach used was effective to some degree for improving discharge processes. Further focus is required on collecting qualitative data to identify the impact on staff, especially related to behaviour and culture change. https://bmjopenquality.bmj.com/content/10/4/e001393 http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjoq-2021-001393
  • Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives

    Thomson, Gill; Balaam, Marie-Claire; Nowland Harris, Rebecca; Crossland, Nicola; Heys, Stephanie; Sarian, Arni; Cull, Joanne; Topalidou, Anastasia; Downe, Soo; Aspire-Covid19 Collaborative Group (2022-01-11)
    To explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study. https://bmjopen.bmj.com/content/12/1/e051965 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 http://dx.doi.org/10.1136/bmjopen-2021-051965
  • What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

    Hetherington, Jeff; Jones, Ian (2021-05-01)
    Children's healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community. Abstract published with permission.
  • The types and effects of feedback received by emergency ambulance staff: a systematic mixed studies review with narrative synthesis

    Wilson, Caitlin (2021-03)
    The phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by enhancing clinical performance and staff mental health (Ivers et al., 2012). Within a pre-hospital context, systematic reviews have been conducted for automated feedback from defibrillators and debrief after simulation, but not on the wider concept of feedback. The aim of this systematic review was to identify, describe and synthesise the published literature on the types and effects of feedback received by emergency ambulance staff. Abstract published with permission.
  • Boerhaave syndrome, a rare oesophageal rupture: a case report

    Horrocks, Rebecca (2021-03)
    Boerhaave syndrome is a disorder mainly unknown among ambulance staff. However, the high mortality and morbidity rates associated with this rare disorder, and the fact that other conditions present with similar symptoms, suggest that this is one disorder to add to the differential diagnosis list. This case study describes a 17-year-old male complaining of left-sided 'pressure'-type chest pain and persistent vomiting who on examination was found to have subcutaneous emphysema present. Deceived by a differential diagnosis, the patient was transferred under the belief that he had suffered a spontaneous pneumothorax as he was tall, young and thin. This case report reviews the literature surrounding Boerhaave syndrome and how it can present. Abstract published with permission.
  • How it's done: search tools and techniques for major bibliographic databases

    Holland, Matt; Dutton, Michelle; Glover, Steve (2021-05)
    This article explains how to write an effective search plan using simple steps. The article takes you through the tools and techniques that are widely used in major bibliographic databases such as MEDLINE and CINAHL to conduct searches. These include Boolean logic, truncation and wildcards, in-field searching, proximity operators, limits and subject thesauri. Each process is illustrated with an example to help you apply them to your own searches. The process of using these tools and techniques to either narrow (find fewer results) or broaden (find more results) is described and summarised in an easy-to-use table. Abstract published with permission.
  • Use of a modified Delphi process to develop research priorities in major trauma

    McElroy, Luke; Robinson, Lisa; Battle, Ceri; Laidlow, Lynn; Teager, Alistair; de Bernard, Louis; McGillvray, Jack; Tsang, Kevin; Bell, Steve; Leech, Caroline; et al. (2021-06-16)

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