Recent Submissions

  • Paramedic research literature 2011–2019. A bibliographic analysis of the contents of Amber, the ambulance research repository

    Holland, Matt; Dutton, Michelle (2020-10)
    The data held by amber presents an opportunity to understand the structure of the published paramedic literature, specifically the output of NHS staff working in English ambulance services 2011–2019. This period is of interest because it represents part of the development phase of paramedic research in England. The authors apply a series of bibliometric measures to generate a profile of the published literature. https://emj.bmj.com/content/emermed/37/10/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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.19
  • Why take a peak flow in asthma – a review

    van Wamel, Annelies; Procter, Shaun (2010-02)
    Current asthma protocols advocate the measurement of peak flow expiratory rate (PEFR) by staff in pre-hospital care in their assessment and management of acute asthma. Yet in practice many, if not most, omit to do this. The limited amount of recent research available – which has been conducted by doctors and accident and emergency staff and concerns patients admitted to accident and emergency departments – shows that PEFR is one of the best, if not the best, predictive assessment tool available to ambulance staff. Pulse oximetry and PEFR do not measure the same things and cannot replace each other. Not taking a pre- and post-treatment PEFR is potentially detrimental to patient care and does not comply with Joint Royal Colleges Service Liaison Committee and British Thoracic Society standards. Paramedic-led research on assessment and management of acute asthma in pre-hospital settings is lacking. Abstract published with permission.
  • Clinically unnecessary and avoidable emergency health service use for epilepsy: A survey of what English services are doing to reduce it

    Mathieson, Amy; Marson, Anthony G.; Jackson, Mike; Ridsdale, Leone; Goodacre, Steve; Dickson, Jon M.; Noble, Adam J. (2020-02-19)
  • The prehospital early warning triage tool

    Earley, Darren (2010-12)
    The purpose of this article is to provide background information and guidance in the use of the prehospital early warning triage tool (PHEWT); and completion of the PHEWT documentation. The system is intended to provide an aid to prehospital care clinicians in ensuring all patients (ages 16 years and above) are triaged and conveyed to the department or unit best suited to their needs. In order to bring this triage system to fruition, a forward thinking ambulance service could take this on as a well constructed, multi-centre validation study. The article itself is simply the generation of that idea. Abstract published with permission.
  • Heliox in acute severe asthma in the A&E setting: a review

    Scholes, Steven (2013-09-29)
    Heliox (HeO2) is a mixture of helium and oxygen, often mixed in 80:20 or 70:30 ratios for use in medicine and clinical investigations. Heliox has been available for use in the UK since 2002 and is supplied as Heliox 21 (21% oxygen and 79% helium) by BOC Gases for medical use in asthma, croup, chronic obstructive pulmonary disease and other medical procedures. Heliox use in asthma exacerbations remains largely experimental owing to the limited number of randomized controlled trials. This review aims to critically analyse the efficiency of Heliox use in acute asthma exacerbations in the Accident and Emergency (A&E) setting, evaluate its effectiveness as a medium for nebulization, and assess potential benefits to clinical practice. Prehospital application will also be discussed in moderate-severe asthma exacerbations. It is envisaged that the factors relating to Heliox use in asthma are focused to provide an additional therapy to the current choice of therapies for prehospital clinicians. Abstract published with permission.
  • Acute quadriceps injury: a case study

    Newton, Mark; Walker, Jacqui (2004-12)
  • Practice education in paramedic science: theories and application

    Romano, Vincent (2021-01-02)
    This book is immediately recognisable as another Class Professional Publishing release. For me, this sets the expectation high given the number of previous good quality releases. They are often written by experts in their field and are very paramedic-focused. I was curious if this trend would be followed given it is addressing education—a topic that often draws much of its evidence from the nursing profession, especially around mentorship. However, both authors are registered paramedics with a background in education and have gained their own relevant qualifications. This gives the reader further confidence that this book will be aimed at the learning environment specifically within the prehospital setting. Abstract published with permission.
  • Development of V-FAST: a vision screening tool for ambulance staff

    Rowe, Fiona J.; Dent, Joseph; Allen, Frank; Hepworth, Laura R.; Bates, Rachel (2020-08)
    About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Abstract published with permission.
  • The unique advantages of advanced paramedic practitioners

    Brown, Lucy; Hedgecock, Liz; Simm, Catherine; Swift, Juliette; Swinburn, Andy (2011-03-22)
  • Paramedic clinical leadership

    Martin, John; Swinburn, Andy (2012-03)
    Developing the paramedic profession is at the heart of the mission for the College of Paramedics. As any profession develops it evolves to take leadership and responsibility for a growing body of knowledge that informs practice. Back in 2008 the College published the second edition of the curriculum framework for paramedics clearly outlining the need for the development of roles at a variety of clinical levels. Having these levels populated creates a clinical framework that will deliver patient benefit and develop future paramedic practice. At its recent Council meeting the College outlined the need to develop education standards, clinical guidelines, and voluntary regulation for these emerging elements on the career framework, and is set to do this over the coming year. In this article Andy Swinburn the College Council representative for NW region outlines how the North West Ambulance Service NHS Trust has put into place a structured career development spanning the professional roles from first registration to consultant practice. https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2012.4.3.181 ] 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.2012.4.3.181
  • An alternative model of pre-hospital care for 999 patients who require non-emergency medical assistance

    Blodgett, Joanna M.; Robertson, Duncan; Ratcliffe, David; Rockwood, Kenneth (2017-05)
  • Predictors of effective management of acute pain in children within a UK ambulance service: A cross-sectional study

    Whitley, Gregory A.; Hemingway, Pippa; Law, Graham Richard; Wilson, Caitlin; Siriwardena, Aloysius Niroshan (2020-07)
  • Understanding right ventricular myocardial infarction in prehospital care

    Master, Shamima (2021-02)
    Right ventricular myocardial infarction (RVMI) most commonly occurs in relation to an inferior myocardial infarction. Patients with this condition where the culprit right coronary artery (RCA) is occluded have a poor prognosis. Early recognition and the specific treatment pathway for RVMI differ from the treatment for general acute coronary syndrome (ACS) which could help the paramedic to treat this condition more appropriately. This article explores current guidelines for the recognition and treatment of RVMI and the possible application of specific guidelines in a prehospital setting with regards to using right-sided precordial ECG, the administration of fluids and potential complications arising from vasodilatory drugs. Furthermore, the purpose of this article is to help educate and develop the understanding of RVMI in this high-risk subgroup who have an increased morbidity and mortality. Abstract published with permission.
  • Where to now? Searching beyond Medline

    Holland, Matt; Dutton, Michelle; Glover, Steve (2021-02-10)
    This article looks at the tools available to you to extend your search beyond the major bibliographic sources. The article identifies the type of literature you can find and which tools are suitable to use to find them. It aims to help you to broaden the scope of your search to find more relevant material. There is a warning about predatory journals and the need to take a critical approach to material that has not been peer-reviewed. Abstract published with permission.
  • Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

    Blodgett, Joanna M; Robertson, Duncan; Pennington, Elspeth; Ratcliffe, David; Rockwood, Kenneth (2021-01)
  • How accurate is the prehospital diagnosis of hyperventilation syndrome?

    Wilson, Caitlin; Harley, Clare; Steels, Stephanie (2020-11-09)
    Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18). Conclusions: Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity. Abstract published with permission.
  • End-of-life care within the paramedic context

    Wilson, Caitlin (2020-11-09)
    Edited by Tania Blackmore (2020), Palliative end of life care for paramedics provides a comprehensive overview of palliative and end-of-life care within the context of paramedic practice. This recently published book is in its first edition and is available in paperback (£29.99) or eBook (£24.99) format. It sits alongside similar publications from the College of Paramedics such as Law and ethics for paramedics and Independent prescribing for paramedics. Some of you may have noticed that these book topics reflect a selection of the paramedic e-Learning modules, which are freely available for College of Paramedic members through the e-Learning for Healthcare Hub website or via My ESR for NHS employees. The subjects covered in the ‘Paramedic – End of Life and Palliative Care’ e-Learning module loosely reflect those covered in this book; however, the book covers everything in much more detail, and includes many references to current supporting evidence, providing the reader with a greater background understanding of palliative care. The team of authors is a well-balanced mixture of academic and clinical health professionals, with three from a paramedic background and three end-of-life care specialists. The front cover of the book indicates that this book is supported by the College of Paramedics, which hints at its incredible relevance for paramedics and emergency ambulance technicians practising in the UK. Sometimes when being taught by specialists outside of the ambulance service, they impart an immense amount of specialist knowledge, yet prehospital clinicians have to decide for themselves how much is actually within their scope of practice and therefore applicable to their clinical role. Although, the editor includes a (very valid and important) disclaimer at the beginning of the book that ‘healthcare professionals should always follow local procedures and be aware of their own scope of practice’, this process of critical appraisal and judgement on applicability is made much easier by the book's close alignment with UK paramedic practice and the frequent references to the JRCALC Clinical Guidelines 2019 (Association of Ambulance Chief Executives (AACE), 2019). In fact, in that way, it is similar to the Emergency birth in the community book that I reviewed in a past issue of the Journal of Paramedic Practice (Wilson, 2019), which was supported by the AACE and JRCALC. The book takes the reader on a logical journey beginning with the broader historical, social and cultural debates about death and dying in chapter 1, followed by the various definitions of palliative care in chapter 2. Chapters 3 and 4 provide an overview of palliative care emergencies and how to recognise them, followed by guidance on symptom management. Subsequently, chapter 5 focuses on softer skills such as communication, while chapter 6 provides an overview of caring for the dying patient, delirium, medication management and discussions surrounding what may constitute a ‘good death’. Chapters 7 and 8 address the topics of ethics and professional resilience, before chapter 9 ties everything together under the title ‘the paramedic as an end of life care specialist’. A clear favourite within this book was chapter 4, which covers symptom management and seemed so applicable that it may join my ever-growing collection of ‘keep-in-helmet-bag’ books. I also really liked the many visuals, such as the image displaying the relative strength of opioids and others illustrating pain pathways and causes of vomiting and nausea. The authors have also included many educational tables, which in chapter 3 provided useful information on manifestations, relevant considerations and treatment for various palliative care emergencies such as neutropenic sepsis, superior vena cava syndrome and terminal haemorrhage. Although it will be impossible for me to remember all of these details, it will be easy to refer to these tables when thinking through differential diagnoses or reflecting on patient encounters. A great learning tool within this book are the case studies included at the end of most chapters. These cases add a practical element to the book and allow the reader to reflect upon what has been discussed in the chapter. However, many of the case studies and associated questions are complex in nature and although they are likely to have more than one right answer, there will definitely be wrong answers. I wonder if, in subsequent editions, the authors could include potential answers or discussions at the end of the book to ensure that readers are following along the right lines. I found the book to be a bit of a slow starter, as the authors use chapters 1 and 2 to introduce the reader to a wide variety of palliative care policies and frameworks in the UK. Although presented in a structured way, it is at times difficult to see how they fit together and which ones apply to paramedics. For those readers finding themselves similarly confused, I would suggest first turning to chapters 3 or 4 and then revisiting the earlier chapters to learn about the broader picture of palliative care. I think working through this book would make a useful exercise for continued professional development (CPD) as part of a paramedic portfolio or even the associate ambulance practitioner programme. In fact, the title, Palliative and end of life care for paramedics may be slightly misleading: this book is by no means solely suitable for qualified paramedics; emergency ambulance staff in other roles such as emergency medical technicians or clinical advisors within the emergency operations centre would definitely benefit from reading this book, although would have to adapt some of the advice to their own scope of practice. Overall, this book is written in simple and easy-to-understand language, provides excellent tips for further reading and cites relevant and up-to-date references throughout—what's not to love? Well, very little to be honest. I have already recommended this book to several colleagues and feel my own care of patients approaching the end of their life has improved since reading this book. I certainly feel more confident and will likely turn back to this book to answer any prehospital palliative care questions I may face in the future. The best way to summarise this book is by expressing my full agreement with the statement on the back cover: ‘it is essential reading for [prehospital clinicians] hoping to better understand the complexities of caring for patients approaching the end of life’. Abstract published with permission.
  • Challenges of SARS-CoV-2 and conflicting PPE guidelines

    Master, Shamima; Gerrard, Mark (2020-11-09)
    During the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) has become a contentious issue in healthcare settings, no more so than in the prehospital environment. The current severe acute respiratory syndrome 2 virus (SARS-CoV-2) has pathogenic and transmission similarities to previous coronaviruses, severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). There are differences in global and domestic PPE guidelines concerning SARS-CoV-2. Abstract published with permission.

View more