Recent Submissions

  • Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?

    Deakin, Charles; King, Phil; Thompson, F. (2009-11-24)
    Introduction: Ambulance paramedics are now trained routinely in advanced airway skills, including tracheal intubation. Initial training in this skill requires the insertion of 25 tracheal tubes, and further ongoing training is attained through clinical practice and manikin-based practice. In contrast, training standards for hospital-based practitioners are considerably greater, requiring approximately 200 tracheal intubations before practice is unsupervised. With debate growing regarding the efficacy of paramedic intubation, there is a need to assess current paramedic airway practice in order to review whether initial training and maintenance of skills provide an acceptable level of competence with which to practice advanced airway skills. Methods: All ambulance patient report forms (anonymised) for the period 1 January 2007 to 31 December 2007 were reviewed, and data relating to airway management were collected. Paramedic and technician identification codes were used to determine the number of airway procedures undertaken on an individual basis. Results: Of the 269 paramedics, 128 (47.6%) had undertaken no intubation and 204 (75.8%) had undertaken one or less intubation in the 12-month study period. The median number of intubations per paramedic during the 12-month period was 1.0 (range 0–11). A total of 76 laryngeal mask insertion attempts were recorded by 41 technicians and 30 paramedics. The median number of laryngeal mask insertions per paramedic/technician during the 12-month period was 0 (range 0–2). A survey of ongoing continuing professional development across all ambulance trusts demonstrated no provision for adequate training to compensate for the lack of clinical exposure to advanced airway skills. Conclusion: Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews is likely to be inadequate with such infrequent exposure to the skill. https://emj.bmj.com/content/26/12/888. 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/ DOI http://dx.doi.org/10.1136/emj.2008.064642
  • The theory and application of pulse oximetry

    Mildenhall, Joanne (2008-11)
    Pulse oximetry is widely used in the prehospital environment, yet researchers question whether health professionals fully understand the theory to support the practical application of its use. This article explores the fundamental theory of pulse oximetry to give applied understanding. From a prehospital perspective, it details and examines the advantages and limitations of this observational aid, which must be considered when making clinical decisions regarding a patient’s care. Abstract published with permission.
  • Long term outcomes of participants in the paramedic-2 randomised trial of adrenaline in out of hospital cardiac arrest

    Haywood, K.; Ji, Chen; Quinn, Tom; Nolan, Jerry; Deakin, Charles; Scomparin, Charlotte; Lall, Ranjit; Gates, Simon; Long, John; Regan, Scott; et al. (2020-10)
    We recently reported early outcomes in patients enrolled in a randomised trial of adrenaline in out-of-hospital cardiac arrest: the PARAMEDIC-2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial. The purpose of the present paper is to report long-term survival, quality of life, functional and cognitive outcomes in cardiac arrest patients who survived. https://emj.bmj.com/content/37/10/e4.2 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.6
  • Bacterial tonsillitis: prevalence, prediction and treatment by the ECP

    Winch, Spencer (2010-09)
    Sore throat or tonsillitis is not necessarily considered a life-threatening emergency but such calls are received and attended to by the ambulance service. It is believed that this is because a face-to-face assessment is often required as the symptoms of a high temperature, headache, lethargy, vomiting and a stiff neck are far too similar to those of meningitis. With complex telephone triage now being performed by nurses and emergency care practitioners (ECP) on clinical support desks within most emergency operation centres, it is hoped that this complaint could be narrowed down and a more appropriate ECP response despatched. When presented with tonsillitis in the community, it is difficult for the practitioner to establish whether the infection is of a bacterial or viral origin. Learned behaviour would suggest that white exudates on the tonsils deem a bacterial origin and requires antibiotic treatment, but this can sometimes be a self limiting illness and antibiotic treatment is not indicated and will only assist with resistance. This article looks as the incidence of bacterial tonsillitis, tools to predict bacterial tonsilitis, and the correct antibiotic and length of course once established. It also briefly touches on the Department of Health's current consultation on paramedic prescribing rights and how a delayed prescription treatment plan cannot be achieved working under a patient group directive (PGD) when treating bacterial tonsillitis. Abstract published with permission.
  • Double sequential defibrillation for refractory ventricular fibrillation cardiac arrest: A systematic review

    Deakin, Charles; Morley, Peter; Soar, Jasmeet; Drennan, Ian R. (2020-06-16)
  • Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration

    England, Ed; Deakin, Charles; Nolan, Jerry; Lall, Ranjit; Quinn, Tom; Gates, Simon; Miller, Joshua; O'Shea, Lyndsey; Pocock, Helen; Rees, Nigel; et al. (2020-06-14)
  • A lesson on adaptability

    Daubney, Ellie (2020-09-07)
    Having just completed her final year as a student paramedic, Ellie Daubney shares some surprising lessons learned and her recent shifts in perspective towards patient care as she undertakes a new role as a temporary newly qualified paramedic during COVID-19. Abstract published with permission.
  • A prospective manikin-based observational study of telephone-directed cardiopulmonary resuscitation

    Cheung, Spencer; Deakin, Charles D.; Hsu, Ruby; Petley, Graham W.; Clewlow, Frank (2007-03)
  • An exploration of the facilitators and barriers to paramedics’ assessment and treatment of pain in paediatric patients following trauma (EX-PAT)

    Handyside, Barry; Pocock, Helen; Deakin, Charles (2020-10)
    A cross-sectional service evaluation within South Central Ambulance Service (SCAS) revealed deficiencies in the assessment and management of paediatric patients’ pain resulting from trauma. This suggested a need for further work to identify facilitators and barriers to pain assessment and management amongst this patient group. Studies looking into the barriers and facilitators to paramedics’ assessment and management of paediatrics in pain have been conducted internationally and not solely in traumatic events. These studies are not transferable to the UK setting due to prehospital emergency care differences within these countries. https://emj.bmj.com/content/37/10/e10.3 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.22
  • Changing paramedic students' perception of people who self-harm

    Ramluggun, Pras; Freeman-May, Andrew; Barody, Gabby; Groom, Nicholas; Townsend, Chloe (2020-10-07)
    Aim: This study aimed to identify whether paramedic students' perceptions of patients who self-harm changed following an educational intervention. Background: Self-harm is a major public health concern with an increasing number of incidents being reported in England. Paramedics are often the first contact for those who self-harm and antipathy to these patients among caregivers, including paramedics, has been reported. Negative attitudes to patients who self-harm from health professionals is a considerable barrier to their care. Education on self-harm for paramedics has been historically inadequate, even though it can potentially improve attitudes and how these practitioners engage with those who self-harm. Method: A pre- and post-survey analysis was undertaken to examine whether any identified unsympathetic perceptions of paramedic students (n=30) towards patients who self-harm would decrease following an educational intervention, using a validated questionnaire measuring attitudes to self-harm. Results: Perceptions of people who self-harm were generally moderately negative prior to the educational intervention, with a significant drop in negative attitudes after it was completed. A survey showed that this drop was also mostly sustained 10 months later. Conclusion: Educational interventions may help to reduce negative perceptions of patients who self-harm in paramedic students. Abstract published with permission.
  • Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup

    Deakin, Charles D.; Thompson, Fizz; Gibson, Caroline; Green, Mark (2007-03-13)
    Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. https://emj.bmj.com/content/24/6/405.long 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: 10.1136/emj.2007.046920

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