Now showing items 41-60 of 126

    • The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

      Perkins, Gavin D.; Kenna, Claire; Ji, Chen; Deakin, Charles D.; Nolan, Jerry P.; Quinn, Tom; Scomparin, Charlotte; Fothergill, Rachael; Gunson, Imogen M.; Pocock, Helen; et al. (2020-03)
    • 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)
    • 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. 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:
    • 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.
    • An evaluation of the role of SCAS in the attendance to call-outs and the transport to hospital of older people with dementia

      Lofthouse-Jones, Chloe; Pocock, Helen; King, Phil; Jadzinski, Patryk; England, Ed; Taylor, Sarah; Cavalier, Julian; Fogg, Carole (2019-09-24)
      Background Our previous work has shown that 35% of ambulance attendances by SCAS are to people aged 75 and over; 17% of these have dementia. The research literature suggests that older people with cognitive impairment/dementia experience longer stays, or die, in hospital. It is unclear whether factors such as call time or availability of social care impact conveyance rates. The aim of this study was to explore the impact of out-of-hours call-outs and social care provision on ambulance conveyance rates for people aged ≥75 years, including patients with dementia. Methods For this service evaluation, electronic records for patients aged ≥75 years attended by SCAS were extracted over one year. The proportion of conveyed patients according to a dementia record, out-of-hours call, time of year, triage grade, social care provision and indices of deprivation were calculated. Univariate and multivariate analyses identified factors which may influence conveyance. Results A total of 111,548 electronic records were included, 16.5% with dementia. 63.7% of calls resulted in conveyance (59.1% with dementia). Conveyances reduced in out-of-hours periods for all patients. 13.6% more patients living alone and 16.5% more patients living with family were conveyed to hospital if there was no care package in place. Adjusted for other factors, having a care package reduced the risk of conveyance in older people living alone by 36% (Odds ratio 0.64, 95% Confidence interval 0.62–0.67). Conclusions Availability of social care and time of call appear to be important determinants of conveyance in older people, both in those with and without dementia. More research is needed to improve needs assessments and local referral services and pathways, 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: DOI
    • 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., . 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: DOI
    • Look at the patient and follow your gut

      Elsey, Abbygail (2019-08-07)
      In this month's issue, Abbygail Elsey shares the best advice she received as a student paramedic, and how it is only now making its impact in her role as a new clinician. Abstract published with permission.
    • 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.
    • 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.
    • 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.
    • Human factors in student paramedic practice

      Matheson, Rose (2019-01-12)
      Abstract published with permission. Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. A personal experience as a student paramedic highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated. Discussions regarding human factors that influence a student paramedic's development on practice placements remain in their infancy. The student paramedic role is unique and challenging, and involves developing a level of resilience that continues post registration. Because of the role's emotive nature, students need to increase their awareness and management of human factors to prevent them from affecting their practice. Equally, educators need to have a greater focus on encouraging and teaching coping strategies. Practitioners who work with students do so whether they choose to be a mentor or not and many may feel unprepared for the role. Interactions between students and clinician mentors are complicated and future research will be required to determine the best approach to aid student development in the placement environment.
    • Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Soar, Jasmeet; Mark, Julian; Mapstone, James; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Bichmann, Anna; et al. (2019-01-01)