• 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)
    • 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
    • Prehospital clearance of the cervical spine: does it need to be a pain in the neck?

      Armstrong, B.P.; Simpson, H.K.; Crouch, Robert; Deakin, Charles (2007-07)
      Prehospital cervical spine (c-spine) immobilisation is common, despite c-spine injury being relatively rare. Unnecessary immobilisation results in a significant burden on limited prehospital and emergency department (ED) resources. This study aimed to determine whether the incidence of unnecessary c-spine immobilisation by ambulance personnel could be safely reduced through the implementation of an evidence-based algorithm. Following a training programme, complete forms on 103 patients were identified during the audit period, of which 69 (67%) patients had their c-spines cleared at scene. Of these, 60 (87%) were discharged at scene, with no clinical adverse events reported, and 9 (13%) were taken to the local ED with non-distracting minor injuries, all being discharged home the same day. 34 (33%) patients could not have their c-spines safely cleared at scene according to the algorithm. Of these, 4 (12%) patients self-discharged at scene and 30 (88%) were conveyed to an ED as per the normal procedure. C-spine clearance at scene by ambulance personnel may have positive impacts on patient care, efficient use of resources and cost to healthcare organisations. https://emj.bmj.com/content/24/7/501 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/emj.2006.041897
    • A prospective infant manikin-based observational study of telephone-cardiopulmonary resuscitation

      Dawkins, S.; Deakin, Charles D.; Baker, K.; Cheung, Spencer; Petley, G.W.; Clewlow, Frank (2008-01-01)
    • Managing the Injury Burden in Nepal

      The Nepal Community Emergency Preparedness Group; Karmacharya, P.C.; Singh, G.K.; Singh, M.P.; Gautam, V.G.; Par, Andrew; Banskota, A.K.; Bajracharya, A.; Shreshtha, A.B.; Mahara, Deepak (2008-10)
    • 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.
    • Is ambulance telephone triage using advanced medical priority dispatch protocols able to identify patients with acute stroke correctly?

      Deakin, Charles; Alasaad, M.; King, P.; Thompson, F. (2009-05-22)
      Background and Purpose: As many as half the patients presenting with acute stroke access medical care through the ambulance service. In order to identify and triage these patients effectively as life-threatening emergencies, telephone-based ambulance software must have high sensitivity and specificity when using verbal descriptions to identify such patients. Software-based clinical coding was compared with the patient’s final clinical diagnosis for all patients admitted by ambulance to North Hampshire Hospital (NHH) emergency department (ED) over a 6-month period to establish the ability of telephone-based triage to identify patients with likely stroke accurately. Methods: All emergency calls to South Central Ambulance Service over a 6-month period resulting in a patient being taken to NHH ED were reviewed. The classification allocated to the patient by ambulance advanced medical priority dispatch software (AMPDS version 11.1) was compared with the final clinical diagnosis made by a doctor in the ED. Results: 4810 patients were admitted to NHH during the study period. Of these, 126 patients were subsequently diagnosed as having had a stroke. The sensitivity of AMPDS software for detecting stroke in this sample was 47.62%, specificity was 98.68%, positive predictive value was 0.49 and negative predictive value was 0.986. Conclusions: Fewer than half of all patients with acute stroke were identified using telephone triage on the initial emergency call to the ambulance service. Less than one quarter received the highest priority of ambulance response. This first link in the chain of survival needs strengthening in order to provide prompt and timely emergency care for these patients. https://emj.bmj.com/content/26/6/442. 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.2008.059733
    • 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
    • A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008

      Deakin, Charles D.; Clarke, Tom; Nolan, Jerry P.; Zideman, David; Gwinnutt, Carl; Moore, Fionna; Keeble, Carl; Blancke, Wim (2010-03)
      Paramedic tracheal intubation has been practised in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcomes. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate, and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (eg, laryngeal mask airway), which were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative prehospital airway device for paramedics. https://emj.bmj.com/content/27/3/226.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. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emj.2009.082115
    • Spinal injury: how should we immobilize in the prehospital environment?

      Warner, Stuart (2010-03)
      Correct spinal immobilization is key to reducing the potential for further injury to the spinal cord. Effective management of actual injuries, or the potential for injury, has led to a protracted debate on which piece of equipment is fully fit for purpose. For the past 20 years, the UK ambulance service has been regularly using the rescue board (colloquially known as the ‘spinal board’) to immobilize patients. This paper seeks to review the current equipment and debate their appropriate applications. Abstract published with permission.
    • Evaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest

      Deakin, Charles D.; Evans, Siân; King, Philip (2010-07)
      Abstract Introduction Telephone-cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest. Methods Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding patient report forms (PRFs) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival. Results Of the 42 calls reviewed, 19 (45.2%) were confirmed as cardiac arrest. CPR was already underway in two cases (10.5%). Of the remaining callers, 11 (64.7%) agreed to attempt T-CPR, resulting in an overall bystander-CPR rate of 68.4%. The median time to open the airway was 126 s (62–236 s, n = 11), deliver the first ventilation was 180 s (135–360 s, n = 11), and perform the first chest compression was 280 s (164–420 s, n = 9). Conclusion Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.
    • The pathophysiology of labyrinthitis

      Mildenhall, Joanne (2010-07)
      Labyrinthitis is an inflammatory response within the membranous inner ear structures in response to infection. It is a generally short-lived minor illness that has the potential to cause temporary or permanent disablement in terms of hearing loss. Other symptoms include nausea and vomiting, pain in the affected ear, vertigo, and fever. Subsequently, it is an illness commonly diagnosed by health care practitioners working in the community setting. Understanding the pathophysiological development and the inflammatory and immune response to such an illness enables the clinician to comprehend the underlying processes of the presenting signs and symptoms, and to treat accordingly. Abstract published with permission.