• Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

      Rajagopal, Sangeerthana; Kaye, Charlotte; Lall, Ranjit; Deakin, Charles D.; Gates, Simon; Pocock, Helen; Quinn, Tom; Rees, Nigel; Smyth, Michael A.; Perkins, Gavin D. (2016-12)
    • Clarifying the design of the PARAMEDIC trial.

      Gates, Simon; Quinn, Tom; Lall, Ranjit; Deakin, Charles D.; Perkins, Gavin D. (2015-07)
    • A clinical audit of the electronic data capture of dementia in ambulance service patient records

      Pocock, Helen; Jadzinski, Patryk; Taylor-Jones, Chloe; King, Phil; England, Ed; Fogg, Carole (2018-03)
      Abstract published with permission. Background: Dementia is a common diagnosis in older people. It is important to identify and record dementia on emergency call-outs, as it impacts on subsequent care decisions. Ambulance services are changing from paper to electronic patient records, but there are limited data on how frequently and in which sections of the electronic patient record dementia is being recorded. Aims: To audit the proportion of ambulance electronic patient records where dementia is recorded for patients aged (i) 65 and above and (ii) 75 and above, and to describe the sections in the electronic patient record in which dementia is recorded, as there is currently no standardised button or field available. Results: A total of 314,786 electronic patient records were included in the audit, over a one-year period. The proportion of attended calls with ‘dementia’ recorded in the electronic patient record in patients aged 65+ was 13.5%, increasing to 16.5% in patients aged 75+, which is similar to that recorded in previous literature. For patients aged 75+ conveyed to hospital, 15.2% had ‘dementia’ recorded in the electronic patient record, which may indicate under-recording. Recording of dementia between Clinical Commissioning Groups varied between 11.0% and 15.3%. Dementia was recorded in 16 different free-text fields, and 38.4% of records had dementia recorded in more than one field. Conclusion: This audit demonstrates high variability in both the frequency of recording dementia and also the location in the electronic patient record. To ensure consistent recording and ease of retrieval to inform patient care and handover, we propose that the electronic patient record should be modified to reflect paramedics’ needs, and those of the healthcare staff who receive and act on the report. Enhanced training for paramedics in the importance and method of recording dementia is required. Future data will enable accurate monitoring of trends in conveyance, and inform justifications for alternative services and novel referral pathways.
    • The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest

      Marti, Joachim; Hulme, Claire; Ferreira, Zenia; Nikolova, Silviya; Lall, Ranjit; Kaye, Charlotte; Smyth, Michael A.; Kelly, Charlotte; Quinn, Tom; Gates, Simon; et al. (2017-08)
    • Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest

      Achana, Felix; Petrou, Stavros; Madan, Jason; Khan, Kamran; Ji, Chen; Hossain, Anower; Lall, Ranjit; Slowther, Anne Marie; Deakin, Charles; Quinn, Tom; et al. (2020-09-27)
    • 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
    • Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

      Myall, Michelle; Rowsell, Alison; Lund, Susi; Turnbull, Joanne; Arber, Mick; Crouch, Robert; Pocock, Helen; Deakin, Charles; Richardson, Alison (2020-09-18)
      To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. https://bmjopen.bmj.com/content/10/9/e036925 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/bmjopen-2020-036925
    • Developing and validating a new national remote health advice syndromic surveillance system in England

      Harcourt, S.E.; Morbey, R.A.; Loveridge, Paul; Carrilho, L.; Baynham, D.; Povey, E.; Fox, Peter; Rutter, J.; Moores, P.; Tiffen, J.; et al. (2017-03)
    • Diagnosing and imaging renal calculi: what can be done in the pre-hospital environment?

      McPherson, Melinda (Dolly) (2016-02)
      Abstract published with permission. Renal colic is a common pre-hospital presentation that is often conveyed to hospital due to diagnostic uncertainty. The use of the STONE score and a greater understanding of computerised tomography (CT) requirement in the diagnostic process can aid the pre-hospital clinician in making an informed decision about the management of these patients. Case: A 48-year-old female presenting with symptoms of renal colic who was assessed, managed and treated at home. Methods: A literature search was carried out on Medline, Cinahl, BNI and Embase. In addition, searches of the NHS evidence database (www.evidence.nhs.uk) and the Cochrane Database of Systematic Reviews (www.cochrane.org) were completed. Results: The search yielded 536 results, each of which were browsed for relevance, duplicates removed and their references reviewed. 16 articles were relevant to the use of CT to diagnose renal calculi and four addressed the derivation and validation of the STONE score. These were critically reviewed and conclusions drawn about their applicability to the pre-hospital environment. Conclusions: The STONE score, when combined with clinical judgement and if applied to the right patient group, is an appropriate clinical decision tool to identify uncomplicated renal calculi. CT imaging of this low-risk patient group is not required to confirm diagnosis; however, delayed CT scanning is required to form a management plan.
    • Documentation: are we writing it right?

      Eaton, Georgette (2014-09)
      Abstract published with permission. While the need to keep accurate patient records is acknowledged by the bodies that govern healthcare practice, there is currently little evidence to support a specific standard of record keeping, with advice on following one of several recognised models. For many ambulance Trusts, documentation guidelines are based on expert opinion of what should constitute good medical records and documentation, but this can vary from region to region. However, whichever model is used, there are several core principles that should be used when writing medical documentation. This article aims to provide ambulance staff with general information on documentation in an attempt to enable readers to understand why records are kept, the standard to which records should be kept, and the legal and regulatory issues relating to record-keeping for paramedics.
    • Double sequential defibrillation for refractory ventricular fibrillation cardiac arrest: A systematic review

      Deakin, Charles; Morley, Peter; Soar, Jasmeet; Drennan, Ian R. (2020-06-16)
    • The effect of airway management on CPR quality in the PARAMEDIC2 randomised controlled trial

      Deakin, Charles; Nolan, Jerry P.; Ji, Chen; Fothergill, Rachael; Quinn, Tom; Rosser, Andy; Lall, Ranjit; Perkins`, Gavin (2020-11-12)