• Clinical navigation for beginners: the clinical utility and safety of the Paramedic Pathfinder

      Newton, Mark; Tunn, Eddie; Moses, Ian; Ratcliffe, David; Mackway-Jones, Kevin C. (2014-10)
      Background English Ambulance Services are faced with annual increases in emergency demand. Addressing the demand for low acuity emergency calls relies upon the ability of ambulance clinicians to accurately identify the most appropriate destination or referral pathway. Given the risk of undertriage, the challenge is to develop processes that can safely determine patient dispositions, thereby increasing the number of patients receiving care closer to home. Aims The aim of the study was to evaluate the clinical utility and safety of triage support tools (Paramedic Pathfinders). Methods Two triage filters (Pathfinders) were developed (one medical, one trauma). These were applied by ambulance clinicians to 481 patients who had been transported to emergency departments (EDs). Preferred (gold standard) patient dispositions were established by senior medical practitioners using both ambulance and ED clinical records. The clinical utility of ambulance clinicians using Pathfinders was evaluated against this gold standard. Results The Medical Pathfinder was applied to 367 patients (76.3%) and the Trauma Pathfinder to 114 (23.7%). Agreement between ambulance clinician and gold standard was achieved in 387 cases (80.5%) giving the tools a combined sensitivity of 94.83% and specificity of 57.9%. 20.9% of medical patients and 30.7% of trauma patients who had been transported to hospital could have been safely cared for elsewhere. Conclusions Ambulance clinicians using Pathfinders have demonstrated acceptable levels of sensitivity in identifying patients who require ED care. The actual impact of the tools in clinical practice will be dependent on the provision of suitable alternatives to ED. https://emj.bmj.com/content/emermed/31/e1/e29.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-2012-202033
    • Creating authentic video scenarios for use in prehospital research

      Preston, Christopher; Carter, Bernie; Jack, Barbara; Bray, Lucy (2017-05)
    • Decision making for refusals of treatment—a framework to consider

      Jones, Steven; Williams, Barry; Monteith, Paul (2014-04)
      Abstract published with permission. Challenges to practice are encountered on a daily basis by paramedics that often share many common recurring themes around consent or refusal to treatment. The benefits of training and open debate acknowledge the often complex decisions relating to consent and mental capacity and reduce opportunities for future legal challenge. How the law should be integrated into everyday decision making will be examined and a framework proposed to assist practice for defendable decision making. This article was inspired following joint training undertaken with paramedics and local critical incident managers from the police, which highlighted a need for a practical decision-making framework to be available for application during incidents and for use as an analytical tool to aid post-decision reflection and learning at debrief.
    • 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.
    • 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.