• 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.
    • Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers

      Freeman, Samuel; Deakin, Charles D.; Nelson, Magnus J.; Bootland, Duncan (2018-11)
      Aim The management of hypothermic casualties is a challenge faced by all prehospital and search and rescue (SAR) teams. It is not known how the practice of these diverse teams compare. The aim of this study was to review prehospital hypothermia management across a wide range of SAR providers in the UK. Methods A survey of ground ambulances (GAs), air ambulances (AAs), mountain rescue teams (MRTs, including Ministry of Defence), lowland rescue teams (LRTs), cave rescue teams (CRTs), and lifeboats and lifeguard organisations (LLOs) across the UK was conducted between May and November 2017. In total, 189 teams were contacted. Questions investigated packaging methods, temperature measurement and protocols for managing hypothermic casualties. Results Response rate was 59%, comprising 112 teams from a wide range of organisations. Heavyweight (>3 kg) casualty bags were used by all CRTs, 81% of MRTs, 29% of LRTs, 18% of AAs and 8% of LLOs. Specially designed lightweight (<0.5 kg) blankets or wraps were used by 93% of LRTs, 85% of LLOs, 82% of GAs, 71% of AAs and 50% of MRTs. Bubble wrap was used mainly by AAs, with 35% of AAs reporting its use. Overall, 94% of packaging methods incorporated both insulating and vapour-tight layers. Active warming by heated pads or blankets was used by 65% of AAs, 60% of CRTs, 54% of MRTs, 29% of LRTs and 9% of GAs, with no LLO use. Temperature measurement was reported by all AAs and GAs, 93% of LRTs, 80% of CRTs, 75% of MRTs and 31% of LLOs. The favoured anatomical site for temperature measurement was tympanic. Protocols for packaging hypothermic casualties were reported by 73% of services. Conclusions This survey describes current practice in prehospital hypothermia management, comparing the various methods used by different teams, and provides a basis to direct further education and research. https://emj.bmj.com/content/35/11/652.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.org/10.1136/emermed-2017-207178
    • 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)
    • Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis.

      Gates, Simon; Quinn, Tom; Deakin, Charles D.; Blair, Laura; Couper, Keith; Perkins, Gavin D. (2015-09)
    • Mechanical chest compression in the PARAMEDIC trial - Authors' reply.

      Perkins, Gavin D.; Quinn, Tom; Deakin, Charles D.; Lall, Ranjit; Gates, Simon (2015-07)
    • Mechanical CPR: Who? When? How?

      Poole, Kurtis; Couper, Keith; Smyth, Michael A.; Yeung, Joyce; Perkins, Gavin D. (2018-05)
    • Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC) : a pragmatic, cluster randomised controlled trial

      Perkins, Gavin D.; Lall, Ranjit; Quinn, Tom; Deakin, Charles D.; Cooke, Matthew W.; Horton, Jessica; Lamb, Sarah E.; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andy; et al. (2015-03)
    • New kid on the block: starting as an NQP

      Elsey, Abbygail (2019-02-04)
      In 2018, our new Student Column shared perspectives from first, second and third year students across UK paramedicine programmes. This year, we will follow Abbygail Elsey, on a quarterly basis, as she takes the first steps of her journey as a newly qualified paramedic at South Central Ambulance Service after her recent graduation from Edge Hill University. Abstract published with permission.
    • Occupational stress, paramedic informal coping strategies: a review of the literature

      Mildenhall, Joanne (2012-06)
      Abstract published with permission. Frontline ambulance staff have high rates of sickness absence; far greater than any other National Health Service worker. Reports suggest that many of these instances are attributable to stress, anxiety and depression. Indeed, studies have observed that occupational stress is significant within the Ambulance Service. While academics frequently associate the causative factor as being related to traumatic incident exposure, there is a small, growing trend of researchers who have found that daily hassles are equally, if not a greater source of stress. Many of the studies investigating the psychological aftermath of a stressful occupational experience focus on formal coping strategies such as critical incident debriefing and trauma risk incident management. However, it has been found that paramedics often prefer to manage stressful feelings informally within their own occupational culture. This literature review explored these informal coping strategies, and found that cognitive mechanisms and peer support were the most used methods. Research in this domain is currently very limited; therefore, this review identifies several areas for further study.
    • Our role in a family's crumbling world

      Elsey, Abbygail (2019-05-07)
      Newly qualified paramedic at South Central Ambulance Service, Abbygail Elsey, shares a personal experience of loss and provides a reminder of just how much a paramedic's role matters to the families who call you to the scene of their loved one's death Abstract published with permission.
    • Pain priorities in pre-hospital care

      Hanson, Susan; Hanson, Ashley; Aldington, Dominic (2017-08)
    • Paramedics and medicines: legal considerations

      England, Ed (2016-08)
      Abstract published with permission. This article will cover: l The relevant legislation relating to medicines and ambulance services l The restrictions that apply to different organisations or individuals regarding the possession of medicines l Regulations on the administration and supply of medicines l Patient Group Directions and Patient Specific Directions. The law in relation to the possession of medicines, administration to patients and the supply of medicines is separate. This article also provides guidance to ambulance services and ambulance clinicians on available options to ensure good patient access to medicines in England. The laws described also apply in Scotland and Wales but there are some different national processes. The law both enables and restricts access to medicines. However, it does require interpretation and a pharmacist can help with this. Where interpretation is contentious then organisations may obtain a legal opinion. Legal opinions can also differ, and can only be resolved in court.
    • 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.
    • Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

      Siriwardena, Aloysius; Asghar, Zahid; Lord, Bill; Pocock, Helen; Phung, Viet-Hai; Foster, Theresa; Williams, Julia; Snooks, Helen (2019-02)
    • 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)
    • Patient, health service factors and variation in mortality following resuscitated out-of-hospital cardiac arrest in acute coronary syndrome: Analysis of the Myocardial Ischaemia National Audit Project

      Couper, Keith; Kimani, Peter K.; Gale, Chris P.; Quinn, Tom; Squire, Iain B.; Marshall, Andrea; Black, John J.M.; Cooke, Matthew W.; Ewings, Bob; Long, John; et al. (2018-03)
    • A pilot study of angiotensin converting enzyme (ACE) genotype and return of spontaneous circulation following out-of-hospital cardiac arrest

      Lindner, Thomas W.; Deakin, Charles D.; Aarsetoy, Hildegunn; Rubertsson, Sten; Heltne, Jon-Kenneth; Soreide, Eldar (2014-08)
      Objective In the last few years the genetic influence on health and disease outcome has become more apparent. The ACE genotype appears to play a significant role in the pathophysiology of several disease processes. This pilot study aims at showing the feasibility to examine the genetic influence of the ACE genotype on return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Methods We performed a prospective observational study of all OHCAs of presumed cardiac origin in a well-defined population. We collected prehospital blood samples for the determination of ACE genotype and used this information together with Utstein template parameters in a multivariable analysis to examine the relationship between ROSC and ACE genotype. Results We collect blood samples in 156 of 361 patients with OHCA of presumed cardiac origin, 127 samples were analysed (mean age 67 years, 86% male, 79% witnessed OHCA, 80% bystander CPR, 62% had a shockable rhythm, ROSC 77%). Distribution of the ACE gene polymorphisms: insertion polymorphism (II) n=22, 17%, insertion/deletion polymorphism (ID) n=66, 52% and deletion polymorphism (DD) n=39, 31%. We found no significant association between ACE II vs ACE DD/DI and ROSC (OR 1.72; CI 0.52 to 5.73; p=0.38). Other ACE genotype groupings (II/ID vs DD or II vs DD) did not change the overall finding of lack of impact of ACE genotype on ROSC. Conclusions This pilot study did not indicate a significant association between ACE gene polymorphism and ROSC. However, it has demonstrated that prehospital genetic studies including blood sampling are feasible and ethically acceptable. https://openheart.bmj.com/content/openhrt/1/1/e000138.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/openhrt-2014-000138
    • Point-of-care blood tests in decision-making for people over 65 with acute frailty

      McPherson, Melinda (Dolly) (2019-03-13)
      Background: National ‘see, treat and discharge’ rates for paramedics have increased. However, despite the rise in demand on paramedic decision-making, there have been few improvements to prehospital diagnostics. Patients aged over 65 years presenting with acute frailty syndromes are a notably complex clinical patient group for whom informed risk stratification in clinical reasoning is paramount. Methods: This was a single-site quality improvement project using point-of-care blood testing (POCbT) to help inform decision-making for patients aged above 65 years with acute frailty syndromes. Results: This quality improvement project showed a self-reported improved confidence in clinician decision-making and patient disposition with the use of POCbT. This confidence was validated by improved discharge on scene and recontact rates. An unintended outcome of the project was the accumulation of practical knowledge on the use of POCbT in the prehospital arena. Conclusion: Continued use of POCbT in the prehospital environment has promise but this is not without limitations. Prehospital services wishing to implement POCbT should focus on demographic identification, staff training and interpretation of results. Abstract published with permission.
    • Post-admission outcomes of participants in the PARAMEDIC trial: a cluster randomised trial of mechanical or manual chest compressions

      Ji, Chen; Lall, Ranjit; Quinn, Tom; Kaye, Charlotte; Haywood, K.; Horton, Jessica; Gordon, V.; Deakin, Charles D.; Pocock, Helen; Carson, Andrew; et al. (2017-09)