• Creating authentic video scenarios for use in prehospital research

      Preston, Christopher; Carter, Bernie; Jack, Barbara; Bray, Lucy (2017-05)
    • Developing understanding and awareness of children’s distress, distraction techniques and holding

      Preston, Christopher; Bray, Lucy (2015-03)
      Abstract published with permission. Purpose: This project aimed to evaluate the influence of an education session on ambulance clinicians’ understanding and awareness of children’s distress, distraction techniques and holding in the pre-hospital setting. Methods: An inter-professional education session that focused on raising awareness of children’s distress, the use of distraction techniques and clinical holding during pre-hospital care was provided. A mixed methods approach was then used to evaluate both existing and newly acquired knowledge and opinion through the use of questionnaires (n=26) and focus group discussion (n=20). Results: Despite literature suggesting that ambulance clinicians may not use distraction techniques during pre-hospital care, data gained from this project indicates that use of distraction techniques is widespread (92%, n=24) and has been adapted to fit within pre-hospital care. The inter-professional education event was reported as being of value for ambulance clinicians. Conclusions: Ambulance clinicians endeavour to provide a positive experience for children undergoing procedures, despite reported limitations in education, exposure and equipment. By using a collaborative and consultative education event, it is possible to facilitate ambulance clinicians to challenge their practice and improve their reported knowledge of dealing with children during procedures in the pre-hospital setting. Additional work needs to be undertaken to further explore and improve pre-hospital practice in relation to children’s distress and clinical procedures.
    • Paramedic attitudes towards DNACPR orders

      Armitage, Ewan; Jones, Colin (2017-10)
      Abstract published with permission. Background: Qualitative research involving paramedics and their involvement in end-of-life (EoL) care has already been published, but there have been no published attitudinal studies specifically relating to do not attempt cardiopulmonary resuscitation (DNACPR) orders and paramedics working in the pre-hospital setting in the UK. Objective: To gain an understanding of paramedic attitudes towards an increasingly common aspect of paramedic practice, focusing specifically on the pre-hospital environment and identifying any corelation between gender, length of service, and level of educational attainment. Design: A paper-based questionnaire was distributed to all paramedic grades, operational out of two ambulance stations of a regional NHS ambulance service in March 2017. The questionnaires were designed using a combination of free-text boxes and Likert scales. A total of 33 questionnaires were issued and 11 completed questionnaires were returned. Results: Respondents indicated the importance of communication in relation to DNACPR orders, as well as the role of allied health professionals and family members in the process. Respecting the patient’s wishes was considered paramount, as was educational provision surrounding DNACPRs. Conclusion: The majority of respondents reported that they were comfortable incorporating DNACPR orders in their clinical practice, although more modest responses were returned regarding the level of education received in this area of paramedicine.
    • Potential use of amiodarone to treat new-onset AF in the pre-hospital setting

      Brown, Philip (2014-08)
      Abstract published with permission. Incidence of atrial fibrillation (AF) is high, it is the most prevalent arrhythmia in the UK, Europe and the USA (Naccarelli et al, 2009; Davis et al, 2012; Dagres et al, 2013) and is associated with significant morbidity, high risk of stroke and mortality (Cottrell, 2012). Clinical guidance from the National Collaborating Centre for Chronic Conditions (NCCCC) (2006) and the National Institute for Health and Care Excellence (NICE) (2006) supports clinicians working in primary and hospital-based emergency care, but not those working in pre-hospital care. Updated guidance from NICE (2014) highlights the importance of providing rapid, personalised, evidence-based care, yet does not provide any guidance for pre-hospital clinicians responding to emergency presentations of AF. Paramedics have knowledge and experience of identifying AF, possess antiarrhythmic, anticoagulant and anti-platelet medications as part of their formulary and possess the necessary skills for obtaining intravenous access. This article reviews the national guidance and available best-evidence to provide safe treatment to patients presenting with new-onset AF and considers areas that merit further research.
    • Pre-hospital diagnostic accuracy for hyperventilation syndrome

      Wilson, Caitlin; Harley, Clare; Steels, Stephanie (2017-10)
      Background Hyperventilation syndrome (HVS) encompasses a wide variety of symptoms and is diagnosed by excluding organic causes for patients’ symptoms. Literature suggests that HVS should be diagnosed and treated pre-hospitally to avoid costly attendances at Accident and Emergency departments. The study aim was to determine diagnostic accuracy for HVS of paramedics and emergency medical technicians (index test) in comparison to hospital doctors (reference standard). Methods A retrospective cross-sectional audit of routine data utilising linked pre-hospital and in-hospital patient records of adult patients (age ≥18 years) transported via emergency ambulance to two Accident and Emergency departments in the United Kingdom from January 2012 – December 2013. Agreement between pre-hospital and in-hospital HVS diagnoses was calculated using percent agreement, Cohen’s kappa and prevalence-adjusted bias-adjusted kappa. Accuracy was measured using sensitivity, specificity, predictive values and likelihood ratios with 95% confidence intervals. Results A total of 19 386 records were included in the analysis. Percent agreement between pre-hospital clinicians and hospital doctors was 98.73%, producing kappa of κ=0.57 and adjusted kappa of PABAK=0.97. Pre-hospital clinicians had a sensitivity 0.88 (0.82, 0.92) and specificity 0.99 (0.99, 0.99) 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). Subgroup analyses for sensitivity were statistically non-significant but for positive predictive values were statistically significant (p<0.001) for the number of pre-hospital diagnoses and patient age. Conclusions Paramedics and emergency medical technicians were able to diagnose HVS pre-hospitally with almost perfect specificity and good sensitivity. Pre-hospital diagnostic accuracy was highest for patients less than 30 years of age and if HVS was the sole diagnosis documented. Following this study, a review of the local ambulance service policy excluding adult HVS patients from referrals to Primary Care Services is anticipated. https://emj.bmj.com/content/34/10/e3.3 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-2017-207114.9
    • The use of the Paediatric Assessment Triangle in the management of the sick child

      Ogden, Kimberley (2016-09)
      Background The Paediatric Assessment Triangle (PAT) has been proven to be effective in the general impression of the health status of the child and can interlink the potential underlying pathophysiology so to alert the clinician into how critically ill/ injured the child might be. It is a rapid ‘hands off’ approach when you first encounter the child. The aim is to highlight the use of this assessment tool to allow the clinician a step wise approach to paediatric care so to enhance our treatment in the prehospital environment. Method A mixed method approach was used to gather quantifiable data from auditing patient report forms over a 3 month period during the implementation of the PAT which was followed by a questionnaire to gather qualitative information from the staff regarding their feelings towards using it. Results Data gathered from patient report forms over the 3 month period after the introduction of the PAT showed an initial baseline of 12% of it being used. Once the tool had been implemented an increase to 63.3% showing a significant uptake from the staff who were trained in its use. The questionnaire indicated that staff were welcoming of the use of the assessment tool and felt more confident when assessing a child. Conclusion The PAT showed a marked increase in being used throughout this project and the majority of staff appeared to be able to utilise it appropriately. An attempt to perform this on a larger scale would be beneficial to gauge whether it would be welcomed on a broader spectrum amongst staff and managers. Recommendations would include receiving more training for paediatrics and for consideration to be made to create a clinical performance indicator for child patients to ensure that patient report forms are being completed appropriately and quality care is being delivered to this category of patients. https://emj.bmj.com/content/emermed/33/9/e4.4.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-2016-206139.16