• A randomized trial of epinephrine in out-of-hospital cardiac arrest

      Perkins, Gavin D.; Ji, Chen; Deakin, Charles D.; Quinn, Tom; Nolan, Jerry P.; Scomparin, Charlotte; Regan, Scott; Long, John; Slowther, Anne-Marie; Pocock, Helen; et al. (2018-08)
    • Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

      Fothergill, Rachael; Emmerson, Amber C.; Iyer, Rajeshwari; Lazarus, Johanna; Whitbread, Mark; Nolan, Jerry P.; Deakin, Charles D.; Perkins, Gavin D. (2019-05)
    • Resuscitating drowned children

      Maconochie, Ian; Deakin, Charles D. (2015-02)
      Comment on Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study. https://www.bmj.com/content/350/bmj.h535.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: 10.1136/bmj.h535
    • A retrospective service evaluation of the presentation of anaphylaxis to a UK ambulance service

      Groom, Nicholas; Taylor, Sarah; England, Ed; Pocock, Helen; Deakin, Charles D. (2019-09-24)
      Background There is a lack of data relating to frequency and presentation of anaphylaxis to the ambulance service in England. Little research exists relating to the patients’ self-treatment of anaphylaxis and there is an absence of evidence to evaluate the impact of self-administered adrenaline, there is a need to describe this patient group to evaluate any potential to develop their care. Methods Retrospective data were collected from the electronic patient records of a single NHS ambulance service serving a population of approximately four million. Records between 1stApril 2017 and 31st March 2018 were included where a diagnosis of anaphylaxis was recorded. Gender, age, incident location, allergy history, were summarised to identify any trends in presentation. The frequency of patient self-administration, as well as ambulance administration, of adrenaline was also included for analysis to determine any correlation. Results 326 records were included in the analysis. The mean, median and modal patient ages were 34, 29 and 20 respectively. Patient ages ranged from six months to 95 years. Patients were 65% female, 35% male and 59% of incidents occurred at home. 76% of patients reported having a known allergy with food being the most common allergen (44%). Peak times for calling 999 were midday and 6pm. 35% of patients had self-administered adrenaline. 52% received ambulance-administered adrenaline. The doses of self-administered adrenaline ranged from 0–3 doses and ambulance administered adrenaline ranged from 0–8 doses. Patients who self-administered adrenaline were less likely to receive further adrenaline from the ambulance service. No correlation was found between the number of self-administered doses and ambulance administered doses. Conclusion Patient demographics such as age, gender and allergies were consistent with two previous small-scale studies. This study suggests that early self-administration of adrenaline is beneficial. Opportunities for improvements in data recording as well as patient education were identified., .https://emj.bmj.com/content/36/10/e9.2 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. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.20
    • Saving lives with public access defibrillation: a deadly game of hide and seek

      Sidebottom, David B.; Potter, Ryan; Newitt, Laura K.; Hodgetts, Gillian A.; Deakin, Charles D. (2018-07)
    • Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

      Turnbull, Joanne; McKenna, Gemma; Prichard, Jane; Rogers, Anne; Crouch, Robert; Lennon, Andrew; Pope, Catherine (2019-07)
    • A shocking picture: Automated external defibrillators are poorly signposted in the community

      Sidebottom, David B.; Potter, Ryan; Hodgetts, Gillian A.; Deakin, Charles D. (2017-09)
    • Should oral steroids be routinely supplied to prevent asthmatic relapse?

      Hobson, Mark (2017-08)
      Abstract published with permission. In 2014, the National review of Asthma Deaths recognised the significant burden of associated morbidity, amongst avoidable factors and recent contact with healthcareprofessionals that commonly occur prior to a fatal asthma exacerbation. It also recognised delayed and undersupply of preventer medications, particularly oral steroids, that are linked to relapsing into a repeat exacerbation. Oral steroids are not without significant systemic side effects and carry their own risks which must be balanced against the risk of relapse. This literature review seeks to establish if oral steroids should be routinely supplied to prevent asthmatic relapse. Exacerbations induced by viruses, allergies and medications are commonly known to contribute towards deterioration and these high risk patients have been found to gain the most benefit from a 7-10 day course of oral steroids. This is recommended as an effective, cheap and safe option with minimal side effects for higher risk patients. Paramedics should consider supplying, or obtaining a supply of oral steroids for high risk asthmatics following an acute exacerbation of asthma when the patient does not require, or refuses, further assessment or observation in an accident and emergency department.
    • Speaking up — even when not heard

      Elsey, Abbygail (2020-06-05)
      Decisions made at the end of a patient's life can be some of the most difficult. This month, Abbygail Elsey, shares her most challenging experience yet as a newly qualified paramedic. Abstract published with permission.
    • 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.
    • SQIFED: a new reflective model for action learning

      Pocock, Helen (2013-03)
      Abstract published with permission. Action learning is a much under-used aid to professional development within the NHS. As a reflective tool its strength lies in the contribution of a group to an individual’s interpretation of real-life problems. With the increasing demand on clinicians to maintain records of their professional development a structured reflective model for action learning would provide the vehicle by which the action learning experience may be recorded and presented. The SQIFED model is presented and described here. SQIFED facilitates not only reflection on the immediate key issue but also the opportunity to revisit the scenario with a fresh focus.
    • Temporal changes in bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Hawkes, Claire A.; Booth, Scott J.; Fothergill, Rachael; Black, Sara; Bichmann, Anna; Pocock, Helen; Soar, Jasmeet; Mark, Julian; Perkins, Gavin D. (2017-09)
    • 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.
    • Underutilisation of public access defibrillation is related to retrieval distance and time-dependent availability

      Deakin, Charles D.; Anfield, Steve; Hodgetts, Gillian A. (2018-08)
      Introduction Public access defibrillation doubles the chances of neurologically intact survival following outof-hospital cardiac arrest (OHCA). Although there are increasing numbers of defibrillators (automated external defibrillator (AEDs)) available in the community, they are used infrequently, despite often being available. We aimed to match OHCAs with known AED locations in order to understand AED availability, the effects of reduced AED availability at night and the operational radius at which they can be effectively retrieved. Methods All emergency calls to South Central Ambulance Service from April 2014 to April 2016 were screened to identify cardiac arrests. Each was mapped to the nearest AED, according to the time of day. Mapping software was used to calculate the actual walking distance for a bystander between each OHCA and respective AED, when travelling at a brisk walking speed (4 mph). Results 4012 cardiac arrests were identified and mapped to one of 2076 AEDs. All AEDs were available during daytime hours, but only 713 at night (34.3%). 5.91% of cardiac arrests were within a retrieval (walking) radius of 100m during the day, falling to 1.59% out-of-hours. Distances to rural AEDs were greater than in urban areas (P<0.0001). An AED could potentially have been retrieved prior to actual ambulance arrival in 25.3% cases. Conclusion Existing AEDs are underused; 36.4% of OHCAs are located within 500m of an AED. Although more AEDs will improve availability, greater use can be made of existing AEDs, particularly by ensuring they are all available on a 24/7 basis. https://heart.bmj.com/content/heartjnl/104/16/1339.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/heartjnl-2018-312998
    • Values: what are they worth in paramedicine?

      Eaton, Georgette; Mason, Paige (2018-12)