• Bacterial tonsillitis: prevalence, prediction and treatment by the ECP

      Winch, Spencer (2010-09)
      Sore throat or tonsillitis is not necessarily considered a life-threatening emergency but such calls are received and attended to by the ambulance service. It is believed that this is because a face-to-face assessment is often required as the symptoms of a high temperature, headache, lethargy, vomiting and a stiff neck are far too similar to those of meningitis. With complex telephone triage now being performed by nurses and emergency care practitioners (ECP) on clinical support desks within most emergency operation centres, it is hoped that this complaint could be narrowed down and a more appropriate ECP response despatched. When presented with tonsillitis in the community, it is difficult for the practitioner to establish whether the infection is of a bacterial or viral origin. Learned behaviour would suggest that white exudates on the tonsils deem a bacterial origin and requires antibiotic treatment, but this can sometimes be a self limiting illness and antibiotic treatment is not indicated and will only assist with resistance. This article looks as the incidence of bacterial tonsillitis, tools to predict bacterial tonsilitis, and the correct antibiotic and length of course once established. It also briefly touches on the Department of Health's current consultation on paramedic prescribing rights and how a delayed prescription treatment plan cannot be achieved working under a patient group directive (PGD) when treating bacterial tonsillitis. Abstract published with permission.
    • How do patients with osteoporosis make sense of their doctors’prescribing decisions?

      England, Ed; Portlock, Jane; Brown, Dave; Stephens, Martin (2010-09-30)
    • 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
    • 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.
    • 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.
    • 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)
    • 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.
    • Extending access to specialist services: the impact of an onsite helipad and analysis of the first 100 flights

      Freshwater, Eleanor S.; Dickinson, Phillip; Crouch, Robert; Deakin, Charles D.; Eynon, C. Andy (2014-02)
      Background In November 2011, University Hospital Southampton (UHS), now a major trauma centre, opened its onsite helipad, allowing patients to be brought to the emergency department (ED) directly by air ambulance. Prior to this, helicopters were required to land at a local playing field and the patient had to be transferred by land ambulance. This study aims to investigate the impact this change in practice has had on the flow of patients to the ED. Methods The authors completed a retrospective case analysis of the first 100 patients brought directly to UHS by helicopter. Data were obtained from ED notes and helicopter provider databases. Analysis was conducted on the type of incident and appropriateness of referral. Incident locations were plotted geographically. Results 100 patients arrived at UHS ED by helicopter between 17 November 2011 and 31 March 2012. Of these, 79 were primary helicopter emergency medical service (HEMS) missions and 21 were secondary transfers from other hospitals. Of the HEMS patients, 38 were likely to have been transported to another hospital, had there not been an onsite helipad at UHS. 29 passed another suitable receiving hospital en route and therefore may have come to UHS for speciality services. Conclusions The provision of an onsite, 24 h helipad facility at UHS has resulted in a significant number of patients being transported to the hospital by helicopter who might otherwise have attended an alternative hospital. https://emj.bmj.com/content/emermed/31/2/121.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-2012-201948
    • Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest

      Deakin, Charles D.; Shewry, Elizabeth; Gray, Huon H. (2014-04)
      Introduction Public access defibrillation (PAD) prior to ambulance arrival is a key determinant of survival from out-of-hospital (OOH) cardiac arrest. Implementation of PAD has been underway in the UK for the past 12 years, and its importance in strengthening the chain of survival has been recognised in the government's recent ‘Cardiovascular Disease Outcomes Strategy’. The extent of use of PAD in OOH cardiac arrests in the UK is unknown. We surveyed all OOH cardiac arrests in Hampshire over a 12-month period to ascertain the availability and effective use of PAD. Methods A retrospective review of all patients with OOH cardiac arrest attended by South Central Ambulance Service (SCAS) in Hampshire during a 1-year period (1 September 2011 to 31 August 2012) was undertaken. Emergency calls were reviewed to establish the known presence of a PAD. Additionally, a review of all known PAD locations in Hampshire was undertaken, together with a survey of public areas where a PAD may be expected to be located. Results The current population of Hampshire is estimated to be 1.76 million. During the study period, 673 known PADs were located in 278 Hampshire locations. Of all calls confirmed as cardiac arrest (n=1035), the caller reported access to an automated external defibrillator (AED) on 44 occasions (4.25%), successfully retrieving and using the AED before arrival of the ambulance on only 18 occasions (1.74%). Conclusions Despite several campaigns to raise public awareness and make PADs more available, many public areas have no recorded AED available, and in those where an AED was available it was only used in a minority of cases by members of the public before arrival of the ambulance. Overall, a PAD was only deployed successfully in 1.74% OOH cardiac arrests. This weak link in the chain of survival contributes to the poor survival rate from OOH cardiac arrest and needs strengthening. https://heart.bmj.com/content/heartjnl/100/8/619.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-2013-305030
    • Advice from the Cheshire cat

      Deakin, Charles D. (2014-05)