• Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naive advanced paramedics: trialling a PHUS education programme

      Brooke, Mike; Walton, Julie; Scutt, Diane; Connolly, Jim; Jarman, Bob (2012-04)
      Objective This trial investigated whether advanced paramedics from a UK regional ambulance service have the ability to acquire and interpret diagnostic quality ultrasound images following a 2-day programme of education and training covering the fundamental aspects of lung ultrasound. Method The participants were tested using a two-part examination; assessing both their theoretical understanding of image interpretation and their practical ability to acquire diagnostic quality ultrasound images. The results obtained were subsequently compared with those obtained from expert physician sonographers. Results The advanced paramedics demonstrated an overall accuracy in identifying the presence or absence of pneumothorax in M-mode clips of 0.94 (CI 0.86 to 0.99), compared with the experts who achieved 0.93 (CI 0.67 to 1.0). In two-dimensional mode, the advanced paramedics demonstrated an overall accuracy of 0.78 (CI 0.72 to 0.83), compared with the experts who achieved 0.76 (CI 0.62 to 0.86). In total, the advanced paramedics demonstrated an overall accuracy at identifying the presence or absence of pneumothorax in prerecorded video clip images of 0.82 (CI 0.77 to 0.86), in comparison with the expert users of 0.80 (CI 0.68 to 0.88). All of the advanced paramedics passed the objective structured clinical examination and achieved a practical standard considered by the examiners to be equivalent to that which would be expected from candidates enrolled on the thoracic module of the College of Emergency Medicine level 2 ultrasound programme. Conclusion This trial demonstrated that ultrasoundnaive practitioners can achieve an acceptable standard of competency in a simulated environment in a relatively short period of time. https://emj.bmj.com/content/emermed/29/4/322.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/emj.2010.106484
    • Acute quadriceps injury: a case study

      Newton, Mark; Walker, Jacqui (2004-12)
    • Administering naloxone: is the answer under our noses?

      Bisset, Elspeth (2009-06-01)
      The intranasal (IN) administration of naloxone to treat opioid overdoses offers many benefi ts over the current, often problematic intravenous and intramuscular routes. Such problems include using sharps around potentially aggressive patients; a high risk of transmitting blood-borne infections and diffi culty obtaining intravenous access in injecting drug users. A literature search was undertaken to examine the effectiveness of the IN route of naloxone administration in comparison to these other routes. Research suggests that the IN route is safe to introduce into practice and it is effective: the time taken from ambulance staff arriving at opioid overdose patients to them responding to IN naloxone appears to equal that of the intravenous route. Intranasal naloxone is not yet licensed for use in the UK and this needs to be reviewed. In the future this method of drug administration should result in considerable benefits and improved safety to both ambulance staff and patients, particularly for the treatment of opioid overdoses. Abstract published with permission
    • Adrenal insufficiency: improving paramedic practice

      Baines, Andy (2015-04)
      Abstract published with permission. Acute adrenal insufficiency, which includes Addisonian crisis, can lead to severe morbidity and even death if ineffectively managed. Unfortunately in the pre-hospital setting patients with acute adrenal insufficiency often receive sub-optimal care. The early administration of hydrocortisone in these cases is critical and significantly improves outcomes to the extent it can be life saving. Such therapy is part of current paramedic practice; however, there is evidence that hydrocortisone is rarely used in the pre-hospital setting. Ultimately, patients with acute adrenal insufficiency may currently be sub-optimally managed by paramedics. To combat this, this article will define the current optimal practice in this area and explain how an e-learning package will be used within North West Ambulance Service NHS Trust to educate paramedics in best practice in this area.
    • Advance decisions to refuse treatment and suicidal behaviour in emergency care: 'it's very much a step into the unknown'

      Quinlivan, Leah; Nowland, Rebecca; Steeg, Sarah; Cooper, Jayne; Meehan, Declan; Godfrey, Joseph; Robertson, Duncan; Longson, Damien; Potokar, John; Davies, Rosie; et al. (2019-06-13)
    • 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)
    • 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)
    • The art and science of mentorship in action

      Jones, Paul; Comber, Jason; Conboy, Adrian (2012-08)
      Abstract published with permission. The authors have collaborated to produce this article bringing together more than 60years of combined experience of paramedic practice, education and management. All maintain their paramedic registration and have among their goals the advancement and development of knowledge, skills and professionalism to promote an effective contemporary paramedic who continues to meet the care needs of the communities they serve. Practice mentors are pivotal to the success of a modern, fit-for-purpose paramedic curriculum that requires a significant proportion of learning and assessment to take place in the practice setting. This article focuses on the support that is needed for mentors during major professional and organisational change. Change which is aligned to localised multifaceted organisational strategies and change which includes supporting mentors, enabling them to carry out their function professionally, effectively and with confidence. This article discusses experiences of a collaborative, structured approach to mentorship support which is achieved through organisational, educational and professional alliances. It also explores other approaches and suggests a way forward in terms of a national governance framework.
    • Assessment of frailty in Alzheimer’s: a literature review

      Smith, Kirsty; Wallington, Sophie (2019-07)
    • Asthma: an overview of prehospital care

      Scholes, Steven (2008-12)
      Asthma exacerbations are characterized by progressive increase in shortness of breath, decrease in expiratory airflow, productive or non-productive cough, wheezing and feeling of chest tightness. Emergency hospital admissions for asthma are costly and it is estimated 75% are avoidable through effective asthma management and routine care. This article addresses asthma management in prehospital care explaining relevant underlying pathophysiology of asthma exacerbations to provide clinicians with a greater understanding of asthma and its pharmacological and ventilatory management. Abstract published with permission.
    • 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.
    • 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.
    • Breaking bad news and managing family during an out-of-hospital cardiac arrest

      Mainds, Matthew D.; Jones, Colin (2018-07)
      Abstract published with permission. The management of family during out-of-hospital cardiac arrests and death notification to the family of the deceased in the out-of-hospital setting are topics that are poorly evidenced. Two focus groups consisting of six participants in each were conducted, discussing the two subjects. The results suggest that paramedics prefer family not to be present in the room for a number of reasons and that they don’t feel sufficiently trained by their paramedic courses in order to manage family during resuscitation or breaking bad news. The study highlighted a need for more research on both subjects.
    • Building up a positive culture

      Smith, Daniel (2019-01-12)
    • Bypassing nearest hospital for more distant neuroscience care in head-injured adults with suspected traumatic brain injury: findings of the head injury transportation straight to neurosurgery (HITS-NS) pilot cluster randomised trial

      Lecky, Fiona E.; Russell, Wanda; McClelland, Graham; Pennington, Elspeth; Fuller, Gordon W.; Goodacre, Steve; Han, Kyee; Curran, Andrew; Holliman, Damian; Chapman, Nathan; et al. (2017-10)
      Objective Reconfiguration of trauma services, with direct transport of patients with traumatic brain injury (TBI) to specialist neuroscience centres (SNCs)— bypassing non-specialist acute hospitals (NSAHs), could improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) may worsen outcomes when compared with selective secondary transfer from nearest NSAH to SNC. We conducted a pilot cluster randomised controlled trial to determine the feasibility and plausibility of bypassing suspected patients with TBI —directly into SNCs—producing a measurable effect. Setting Two English Ambulance Services. Participants 74 clusters (ambulance stations) were randomised within pairs after matching for important characteristics. Clusters enrolled head-injured adults— injured nearest to an NSAH—with internationally accepted TBI risk factors and stable ABC. We excluded participants attended by Helicopter Emergency Medical Services or who were injured more than 1 hour by road from nearest SNC. Interventions Intervention cluster participants were transported directly to an SNC bypassing nearest NSAH; control cluster participants were transported to nearest NSAH with selective secondary transfer to SNC. Outcomes Trial recruitment rate (target n=700 per annum) and percentage with TBI on CT scan (target 80%) were the primary feasibility outcomes. 30-day mortality, 6-month Extended Glasgow Outcome Scale and quality of life were secondary outcomes. Results 56 ambulance station clusters recruited 293 patients in 12 months. The trial arms were similar in terms of age, conscious level and injury severity. Less than 25% of recruited patients had TBI on CT (n=70) with 7% (n=20) requiring neurosurgery. Complete case analysis showed similar 30-day mortality in the two trial arms (control=8.8 (2.7–14.0)% vs intervention=9.4(2.3–14.0)%). Conclusion Bypassing patients with suspected TBI to SNCs gives an overtriage (false positive) ratio of 13:1 for neurosurgical intervention and 4:1 for TBI. A measurable effect from a full trial of early neuroscience care following bypass is therefore unlikely https://bmjopen.bmj.com/content/bmjopen/7/10/e016355.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/bmjopen-2017-016355
    • Can paramedics avoid A&E departments with patients complaining of non-traumatic chest pain?

      Best, Pete (2017-04)
      Abstract published with permission. The ‘Paramedic Pathfinder’, a triage tool for paramedics, contains a discriminator for patients complaining of non-traumatic chest pain. The pathfinder advises all patients with non-traumatic chest pain to be taken to hospital. Given a background of large numbers of patients complaining of chest pain and the policy direction of UK ambulance services to treat patients closer to home, the inclusion of discriminator in the pathfinder can be challenged. A greater understanding of ACS, university education for paramedics, bedside troponin measurement, ACS risk scoring, current NICE guidelines and rapid access chest pain clinics have been identified as enablers to remove the discriminator safely and assist paramedics in finding suitable alternatives to Accident and Emergency for certain patients. Risk is an important factor in discussing chest pain and establishing the best pathway for patients. The enablers identified need further testing and development in the pre-hospital environment before they can be utilised.