• 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)
    • Pre-hospital assessment of the role of adrenaline: measuring the effectiveness of drug administration in cardiac arrest (PARAMEDIC-2): trial protocol

      Perkins, Gavin D.; Quinn, Tom; Deakin, Charles D.; Nolan, Jerry P.; Lall, Ranjit; Slowther, Anne-Marie; Cooke, Matthew; Lamb, Sarah E.; Petrou, Stavros; Achana, Felix; et al. (2016-11)
    • 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
    • Prehospital clearance of the cervical spine: does it need to be a pain in the neck?

      Armstrong, B.P.; Simpson, H.K.; Crouch, R; 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
    • Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

      Gates, Simon; Lall, Ranjit; Quinn, Tom; Deakin, Charles D.; Cooke, Matthew W.; Horton, Jessica; Lamb, Sarah E.; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andrew; et al. (2017-04)
    • The Prognostic Value of National Early Warning Scores (NEWS) During Transfer of Care From Community Settings to Hospital: A Retrospective Service Evaluation

      inada-kim, matthew; Knight, Thomas; Sullivan, Michelle; Ainsworth-Smith, Mark; Pike, Neil; Richardson, Mathew; Hayward, Gail; Lasserson, Daniel (2020-06-23)
    • A prospective infant manikin-based observational study of telephone-cardiopulmonary resuscitation

      Dawkins, S.; Deakin, Charles D.; Baker, K.; Cheung, S.; Petley, G.W.; Clewlow, F. (2008-01-01)
    • 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)