• Derivation of a Termination of Resuscitation Clinical Decision Rule in the UK

      Jackson, Mike; House, Matthew; McMeekin, Peter; Dinning, Joanne (2017-08)
    • Paramedic administration of glycoprotein inhibitors for ST elevation myocardial infarction

      Dykes, Simon (2012-08-16)
      Abstract published with permission. Until recently, paramedics were routinely delivering out-of-hospital thrombolysis for ST segment elevation myocardial infarction (STEMI). Now that primary percutaneous coronary intervention (PPCI) is the favoured reperfusion strategy, STEMI patients are by-passing the local emergency department and taken directly to the catheterisation laboratory via ambulance. STEMI patients within a rural setting are facing the prospect of extended transfer times for reperfusion of an already ischaemic myocardium, a potentially perilous strategy. Empirical research conducted outside the UK has identified that the pre-hospital administration of a glycoprotein inhibitor improves clinical outcome for STEMI patients. Glycoprotein naturally helps to build the fibrin mesh essential within the clotting process. Inhibition of this process by glycoprotein inhibitors IIb/IIIa (GPI IIb/IIIa) prevents aggregation at receptor sites on platelets. Original research supports the notion that GPI IIb/IIIa involvement improves patient clinical outcome for STEMI in the out-of-hospital phase. Paramedics are typically the first contact for the STEMI patient and it is tangible that paramedics have the appropriate skill and knowledge to diagnose the out-of-hospital STEMI. With this in mind, it is the purpose of this article to discuss the use of pre-hospital GPI IIb/IIIa administration and to argue that this intervention should be administered by paramedic personnel.
    • Terms used to describe key symptoms in out-of-hospital cardiac arrest by people calling 999 emergency medical services: a qualitative analysis of call recordings to two uk ambulance services

      Gibson, Josephine M.E.; Jones, Stephanie P.; Hurley, Margaret; Auton, Mal; Leathley, Michael J.; Sutton, Christopher J.; Bangee, Munirah; Benedetto, Valerio; Chesworth, Brigit; Miller, Colette; et al. (2017-10)
      Background Cardiac arrest outside hospital is a catastrophic medical emergency experienced by an estimated 60 000 people a year in the UK. The speed and accuracy with which cardiac arrest outside hospital is recognised by 999 call handlers is fundamental to improving the chance of survival, but is extremely challenging. We aimed to identify how cardiac arrest is actually described by callers during dialogues with 999 call handlers. Methods Data was obtained from two acute NHS trusts and their two local ambulance trusts for all cases of suspected or actual out-of-hospital cardiac arrest (OHCA) or imminent medically witnessed cardiac arrest (MWCA) which led to transfer to one of the study hospitals, for a one year period (1/7/2013–30/6/2014). The 999 call recordings were listened to in full; words or phrases used by callers to describe clinical signs and symptoms were identified and clustered into key indicator symptoms using a thematic approach. Findings 429 cases of cardiac arrest were identified, of which 246 (57.3%) were dispatched using a ‘cardiac arrest’ code. 6 callers (1.4%) used the term ‘cardiac arrest’ or a synonym. Key indicator symptoms reported most frequently were unconsciousness (64.8%), ineffective breathing (61.9%), and absent breathing (48.8%). Descriptors of conscious level included diverse colloquialisms and terms relating to reduced or fluctuating level of consciousness (17.2%). Descriptors of ineffective breathing included diverse terms relating to slow, fast, irregular, agonal, dyspnoea, and shallow breathing, plus nonspecific terms (e.g. ‘breathing’s funny); and ‘don’t know’ statements. Conclusion Callers’ descriptors of key symptoms of OHCA are varied and include many colloquialisms. Call handler training should include awareness of likely descriptions, particularly of ineffective breathing, which may be more commonly reported than absent breathing. https://emj.bmj.com/content/34/10/e10.1 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-2017-207114.27
    • What happened on Restart a Heart Day 2017 in England?

      Brown, Terry P.; Perkins, Gavin D.; Lockey, Andrew S.; Soar, Jasmeet; Askew, Sara; Mersom, Frank; Fothergill, Rachael; Cox, Emma; Black, Sarah; Lumley-Holmes, Jenny (2018-09)