• HEMS dispatch: A systematic review

      Eaton, Georgette; Brown, Simon; Raitt, James (2018-01)
    • How do patients with osteoporosis make sense of their doctors’prescribing decisions?

      England, Ed; Portlock, Jane; Brown, Dave; Stephens, Martin (2010-09-30)
    • Human factors in prehospital research: lessons from the PARAMEDIC trial

      Pocock, Helen; Deakin, Charles D.; Quinn, Tom; Perkins, Gavin D.; Horton, Jessica; Gates, Simon (2016-08)
      Background There is an urgent need to develop prehospital research capability in order to improve the care of patients presenting to emergency medical services (EMS). The Prehospital Randomised Assessment of a Mechanical compression Device In Cardiac arrest trial, a pragmatic cluster randomised trial evaluating the LUCAS-2 device, represents the largest randomised controlled trial conducted by UK ambulance services to date. The aim of this study was to identify and analyse factors that may influence paramedic attitudes to, and participation in, clinical trials. Methods Personal and organisational experience from this trial was assessed by feedback from a workshop attended by collaborators from participating EMS and a survey of EMS personnel participating in the trial. A work systems model was used to explain the impact of five interwoven themes—person, organisation, tasks, tools & technology and environment—on trial conduct including gathering of high-quality data. Results The challenge of training a geographically diverse EMS workforce required development of multiple educational solutions. In order to operationalise the trial protocol, internal organisational relationships were perceived as essential. Staff perceptions of the normalisation of participation and ownership of the trial influenced protocol compliance rates. Undertaking research was considered less burdensome when additional tasks were minimised and more difficult when equipment was unavailable. The prehospital environment presents practical challenges for undertaking clinical trials, but our experience suggests these are not insurmountable and should not preclude conducting high-quality research in this setting. Conclusions Application of a human factors model to the implementation of a clinical trial protocol has improved understanding of the work system, which can inform the future conduct of clinical trials and foster a research culture within UK ambulance services https://emj.bmj.com/content/emermed/33/8/562.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-2015-204916
    • Human factors in student paramedic practice

      Matheson, Rose (2019-01-12)
      Abstract published with permission. Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. A personal experience as a student paramedic highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated. Discussions regarding human factors that influence a student paramedic's development on practice placements remain in their infancy. The student paramedic role is unique and challenging, and involves developing a level of resilience that continues post registration. Because of the role's emotive nature, students need to increase their awareness and management of human factors to prevent them from affecting their practice. Equally, educators need to have a greater focus on encouraging and teaching coping strategies. Practitioners who work with students do so whether they choose to be a mentor or not and many may feel unprepared for the role. Interactions between students and clinician mentors are complicated and future research will be required to determine the best approach to aid student development in the placement environment.
    • Identification of characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates

      Brown, Terry P.; Hawkes, Claire A.; Booth, Scott J.; Fothergill, Rachael; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Benger, Jonathan R.; et al. (2017-09)
    • Improving the quality of ambulance crew hand-overs: a qualitive study of knowledge transfer in emergency care teams

      Murray, Steve; Crouch, Robert; Pope, Catherine; Lattimer, Val; Thompson, Fizz; Deakin, Charles D.; Ainsworth-Smith, Mark (2011-03)
      Introduction Ambulance crews make 3.6 million emergency journeys each year. Effective patient transfer relies on verbal, non-verbal and documentary handover of complex information in time-limited environments. Weaknesses in ambulance handover have been noted but little work has been done to investigate the process and identify good practice. Research has looked at communication during transfer of care; standardised resuscitation handover formats have been used but do not always improve accuracy. Ineffective handover threatens patient safety, quality and efficiency of care. This study provides an in-depth examination of handover to inform practice and education. Method We are conducting an ethnographic case study of handover in an ambulance Trust. Researchers are accompanying crews as they undertake their day-to-day work, using observation and video-recording to capture handover—from data collection at scene, pre-alerting (by radio, telephone and computer) through to the hospital. We are also collecting information from patient records along with training materials, policies and directives pertaining to handover. Ethnography allows for informal conversations to take place as appropriate during the fieldwork to clarify understandings and explore emerging themes in the analysis. In addition we are using semi-structured interviews with patients, carers, ambulance staff, nurses, doctors and non-clinical hospital staff to explore the handover process. Result The project started 2nd April 2009. This poster will outline the methodology, present some of the emerging themes from our analysis and describe future data collection and analysis plans. Discussion This is an ongoing project. We will present our experience of undertaking this unusual project—especially issues surrounding accessing staff and the practicalities of data collection. By presenting this work we seek to inform future research into emergency care. https://emj.bmj.com/content/emermed/28/3/e1.11.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.2010.108605.19
    • Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England

      Farmer, A.J.; Brockbank, K.J.; Keech, M.L.; England, Ed; Deakin, Charles D. (2012-11)
    • Increasing objectivity in the assessment of interpersonal skills and attitude

      Tanner, Kieron (2014-11)
      Abstract published with permission. The concept of failure to fail has become more widely discussed in paramedic practice over recent years; however, it has been observed that on occasion mentors and managers experience challenges around the non-practical components of paramedic practice. Consideration has been given to identifying those elements of practice which can be more challenging to encapsulate, with the aim of providing objective feedback and where necessary set pass/fail standards. A non-practical skills matrix has been developed for consideration by those responsible for the development of ambulance staff and students. The proposal encourages qualities of the burgeoning concept of distributive leadership, incorporates elements of the document Towards a New Model of Leadership for the NHS (Department of Health (DH), 2013a), and having been mindful of the NHS response to the failings of Mid-Staffordshire and the findings of both Lord Francis’ and the Health Ombudsman (Parliamentary and Health Service Ombudsman, 2011; DH, 2013b), it responsibly aims to aid in the implementation of aspects of the recommendations capturing the current drive towards improved demonstrable compassion in UK care delivery
    • The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

      Perkins, Gavin D.; Kenna, Claire; Ji, Chen; Deakin, Charles D.; Nolan, Jerry P.; Quinn, Tom; Scomparin, Charlotte; Fothergill, Rachael; Gunson, Imogen M.; Pocock, Helen; et al. (2020-03)
    • Initial experience in setting up a medical student first responder scheme in South Central England.

      Seligman, William H.; Ganatra, Sameer; England, David; Black, John J.M. (2016-02)
      Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention in many undergraduate medical curricula. However, there is growing interest in PHEM among medical students and junior doctors. Several programmes are in existence across the UK that serve to provide teaching and exposure of prehospital care to medical students and junior doctors. However, relatively few students are able to gain significant first-hand experience of treating patients in the prehospital phase. In this short report, we discuss our experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Medical students are trained by the regional ambulance service and respond to life-threatening medical emergencies in an ambulance response vehicle. The scheme is likely to benefit the ambulance service by providing a wider pool of trained volunteer first responders able to attend to emergency calls, to benefit patients by providing a quick response at their time of need, and to benefit medical students by providing first-hand experience of medical emergencies in the community. In its first 15 months of operation, SFRs were dispatched to 343 incidents. This scheme can serve as a training model for other ambulance services and medical schools across the UK. https://emj.bmj.com/content/33/2/155.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/ http://dx.doi: 10.1136/emermed-2015-204638
    • Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial

      Nolan, Jerry P.; Deakin, Charles D.; Ji, Chen; Gates, Simon; Rosser, Andy; Lall, Ranjit; Perkins, Gavin D. (2020-01-30)
    • 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
    • Is it safe to leave my patient at home? Interprofessional community-based learning

      Penrose, Heidi; Ainsworth-Smith, Mark; Wills, Carmel; Scallan, Samantha (2019-06)
    • 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.
    • Level of consciousness on admission to a Heart Attack Centre is a predictor of survival from out-of-hospital cardiac arrest

      Deakin, Charles D.; Fothergill, Rachael; Moore, Fionna; Watson, Lynne R.; Whitbread, Mark (2014-07)
    • 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
    • Look at the patient and follow your gut

      Elsey, Abbygail (2019-08-07)
      In this month's issue, Abbygail Elsey shares the best advice she received as a student paramedic, and how it is only now making its impact in her role as a new clinician. Abstract published with permission.
    • Management of an isolated neck-of-femur fracture in an elderly patient

      Eaton, Georgette (2012-07)
      Abstract published with permission. Femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered in a step-wise approach and should be progressive to the patients' needs. Pain relief should be sought through the variety of options open to paramedics and should be initiated immediately. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive adequate analgesia and fluid replacement before any definitive treatment at hospital.