Recent Submissions

  • Trends in use of intraosseous and intravenous access in out-of-hospital cardiac arrest across English ambulance services: a registry-based, cohort study

    Vadeyar, Sharvari; Buckle, Alexandra; Hooper, Amy; Booth, Scott; Deakin, Charles; Fothergill, Rachael; Chen, Ji; Nolan, Jerry P; Brown, Martina; Cowley, Alan; et al. (2023-10)
  • Ambulance head injury guidelines: a-head of the game or in need of review?

    Barrett, Jack; Hipkiss, Kate (2024-01-02)
    Older adults with head injury are a challenging group of patients to the ambulance clinician. Older age, clinical frailty, comorbidities, anticoagulant and antiplatelet medications can contribute to these patients suffering a traumatic intracranial haemorrhage (tICH). Abstract published with permission
  • The Paramedic's guide to research: an introduction

    Whitehead, Ross (MAG Online, 2012-12-07)
    The article reviews the book "The Paramedic's Guide to Research: An Introduction," by P. Griffiths.
  • The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: study protocol for an interventional feasibility randomised controlled trial

    Ollis, Lucie; Skene, Simon; Williams, Julia; Lyon, Richard; Taylor, Cath; SEE-IT Trial Group
    INTRODUCTION: Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients' risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients' injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller's smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS. METHODS AND ANALYSIS: The SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming. ETHICS AND DISSEMINATION: The study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents. TRIAL REGISTRATION NUMBER: ISRCTN11449333. https://bmjopen.bmj.com/content/bmjopen/13/4/e072877.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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/openhrt-2015-000281
  • Prehospital video triage of potential stroke patients in North Central London and East Kent: rapid mixed-methods service evaluation

    Ramsay, Angus; Ledger, Jean; Tomini, Sonila; Hall, Claire; Hargroves, David; Hunter, Patrick; Payne, Simon; Mehta, Raj; Simister, Robert; Tayo, Fola; et al. (2022-09)
  • Predictors of survival from out-of-hospital cardiac arrest

    Chamberlain, Douglas (2010-10-21)
    This year is the 50th anniversary of the introduction of modern resuscitation from cardiac arrest, made possible by the combination of closed chest compressions with external defibrillation and effective artificial ventilation.1 Inevitably this was restricted initially to hospitals, but within a few years the need to counter sudden death in the community led to the development of cardiac ambulances. The appreciation that lethal cardiac arrhythmias are not only due to acute myocardial infarction but can also occur unpredictably from a myriad of causes led to more complex responses. In most developed countries we now have public education on the need for rapid access to help, widespread training in cardiopulmonary resuscitation (CPR), means of early defibrillation where relevant and skilled aftercare—the so-called ‘chain of survival’.2 But daunting problems markedly limit success, irrespective of knowledge and training within the community. Even when death strikes suddenly and prematurely, many cases are complicated by severe underlying pathology that is not always amenable to prompt treatment. Even more importantly, only a very few minutes are available for effective resuscitation before apparently irreversible cerebral and cardiac changes make recovery impossible. Survival from out-of-hospital cardiac arrest (OOHCA) is therefore achieved only in a small minority, even of those ‘too young to die’. Investigating the predictors of success can help to prioritise efforts to improve results that are currently so dire. They have also been used as a guide for recognising futility, with the aim of curtailing resuscitation attempts that may have no chance of success. https://heart.bmj.com/content/96/22/1785 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/
  • Is there an association between 30-day mortality and adrenaline infusion rates in post-ROSC patients? A retrospective observational analysis

    Owens, Peter; Sherriff, Martyn
    Introduction: Revised guidelines for the management of cardiac arrest have placed greater emphasis on early defibrillation and closed chest compressions; subsequently there has been a significant rise in the number of patients gaining a return of spontaneous circulation (ROSC). As a consequence, emergency medical services have realised the importance of therapies delivered during this phase of care. In some Trusts this includes the use of inotropic agents to augment the cardiovascular system and maintain adequate cerebral and coronary perfusion pressures to mitigate the effects of post-cardiac arrest syndrome. Currently, limited evidence exists with regards to the efficacy of such treatments in the pre-hospital phase. Methods: Retrospective observational analysis of out-of-hospital cardiac arrest patients who received an adrenaline infusion by critical care paramedics. Infusion rates, time of call (ToC) to ROSC and 30-day mortality were compared. Results: Over a 2-year period, 202 patients were recorded as having an adrenaline infusion commenced. Of these, 25 were excluded as they did not meet criteria or had incomplete data and 22 were excluded as the infusion was stopped at scene; 155 patients were admitted to hospital. There were no survivors in the non-shockable group and three survivors in the shockable group at 30 days. A rare events analysis found no relationship between infusion rate, ToC to ROSC and 30-day mortality (Wald chi2, 1.37). Conclusion: Commencement of adrenaline infusions in post-ROSC was associated with significant 30-day mortality, especially in non-shockable rhythms. Further research is needed to elucidate whether this intervention has any benefit in the post-ROSC patient. Abstract published with permission.
  • Stroke prehospital video triage for suspected stroke patients: Qualitative analysis of implementation and stakeholder experience in four areas of the English NHS

    Walton, Holly; Aghoram, Prasanna; Bray, George; Dearling, Jeremy; Fulop, Naomi J; Hall, Claire; Hargroves, David; Hunter, Rachael M.; Hunter, Patrick; Ng, Pei Li; et al.
  • Ethnic differences in injury mortality rates among adult emergency healthcare service users in High Income Countries (HIC) – A Scoping Review

    Naha, Gargi; Baghdad, Fadi; Harwood, Sophie; Watkins, Alan; Porter, Alison; John, Ann; Evans, Bridie; Goodacre, Steve; Jones, Jenna; Williams, Julia; et al.
  • 'Family members screaming for help makes it very difficult to don PPE.' a qualitative report on ambulance staff experiences of personal protective equipment (PPE) use and infection prevention and control (IPC) practices during the Covid-19 pandemic

    Eaton-Williams, Peter; Williams, Julia (BMJ, 2022-05-01)
    Background The COVID-19 Ambulance Response Assessment (CARA) study was a prospective, longitudinal survey of UK ambulance staff during the first wave of the COVID-19 pandemic. CARA aimed to evaluate perceptions of preparedness and wellbeing, and to collect staff suggestions to benefit working practices and conditions. Method Three online questionnaires were presented, coinciding with the acceleration, peak and deceleration phases of the first COVID-19 wave in 2020. Inductive thematic analysis was employed to represent 14,237 free text responses from 3,717 participants to 18 free-text questions overall. This report focuses on experiences of IPC practices. Results Many participants lacked confidence in using PPE because of low familiarity, an inadequate evidence-base and changing policy. Some experienced insufficient supply, items of poor quality and suboptimal fit-testing procedure. PPE use was further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices, including decontamination personnel, staff 'bubbles' and limiting exposure through public education and remote triage improvements. Conclusion Repeated poor experiences of implementing IPC practices1 2 demand that lessons are learnt from this pandemic. PPE developed with specific regard for ambulance staff 's unique working environment and for them to receive regular familiarization training in its use would likely benefit performance and confidence. Overall, ambulance staff emphasised the need for IPC policies to be pragmatic, evidence-based and communicated with clarity. https://bmjopen.bmj.com/content/12/Suppl_1/A1.2 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/openhrt-2015-000281
  • “See us as humans. Speak to us with respect. Listen to us." A qualitative study on UK ambulance staff requirements of leadership while working during the COVID-19 pandemic

    Eaton-Williams, Peter; Williams, Julia (BMJ, 2022-09-12)
    Background The COVID-19 Ambulance Response Assessment (CARA) study aimed to enable the experiences of UK frontline ambulance staff working during the first wave of the pandemic to be heard. Specifically, CARA aimed to assess feelings of preparedness and well-being and to collect suggestions for beneficial leadership support. Methods Three online surveys were sequentially presented between April and October 2020. Overall, 18 questions elicited free-text responses that were analysed qualitatively using an inductive thematic approach. Findings Analysis of 14 237 responses revealed participants’ goals and their requirements of leadership to enable those goals to be achieved. A large number of participants expressed low confidence and anxiety resulting from disagreement, inconsistency and an absence of transparency related to policy implementation. Some staff struggled with large quantities of written correspondence and many desired more face-to-face training and an opportunity to communicate with policymakers. Suggestions were made on how best to allocate resources to reduce operational demands and maintain service delivery, and a need to learn from current events in order to plan for the future was stressed. To further support well-being, staff wanted leadership to understand and empathise with their working conditions, to work to reduce the risks and if required, to facilitate access to appropriate therapeutic interventions. Conclusions This study demonstrates that ambulance staff desire both inclusive and compassionate leadership. Leadership should aim to engage in honest dialogue and attentive listening. Resultant learning can then inform policy development and resource allocation to effectively support both service delivery and staff well-being. https://bmjleader.bmj.com/content/7/2/102 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/openhrt-2015-000281
  • The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

    Quinn, Tom; Driscoll, Timothy; Gavalova, Lucia; Halter, Mary; Gale, Chris P; Weston, Clive FM; Watkins, Alan; Munro, Scott; Davies, Glen; Rosser, Andy; et al.
    Background Use of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Objectives To investigate differences in mortality between those who did/did not receive PHECG. Methods Population-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017. Results Of 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30- day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001). Conclusion PHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients https://emj.bmj.com/content/38/9/A2.1 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/openhrt-2015-000281
  • Q waves: do they indicate full thickness infarcts?

    Hitt, Andy (2009-09-28)
    The link between pathological Q waves and myocardial necrosis was first observed at autopsy in the early 20th century, an observation that has continued to influence ECG interpretation to the present day. As students we are taught that pathological Q waves on an electrocardiogram (ECG) represent permanent, full thickness myocardial necrosis thus implying that the damage is done and subsequent treatment futile: but could advancing technology challenge this widely held perception? With the development of cardiac magnetic resonance imaging (CMRI) and positron emission tomography (PET) the question regarding the significance of Q waves has been asked at a new level. The purpose of this article is to compare theory, pathological observations, CMRI/PET studies and to discuss how myocardial stunning and hibernation are influencing our perception of the Q wave. There are many factors that can influence QRS manifestation which may or may not exhibit Q waves that are permanent or transient, sinister or benign and by oversimplifying the significance of these Q waves many patients could be denied life changing treatment. Abstract published with permission
  • Transforming stroke care : pivotal role of the ambulance services

    Davis, David; South, Adrian (2009-02-01)
    Stroke is the brain equivalent of a heart attack. With 1.9 million neurons being lost every minute, early access to acute care is critical. Ambulance clinicians have a vital role in ensuring the rapid assessment and transfer of patients to an acute stroke centre, as the principle barrier to delivering thrombolysis is enabling treatment within the narrow therapeutic time window. Timely management of transient ischaemic attacks (TIAs) reduces mortality, morbidity and use of precious NHS resources. Ambulance services need to develop pathways that embrace the vision of the National Stroke Strategy, risk stratifying patients and facilitating immediate hospital admission or referral to timely clinics. Abstract published with permission
  • NEWS2 in out-of-hospital settings, the ambulance and the emergency department

    Tavare, Alison; Pullybank, Anne; Redfern, Emma; Collen, Andy; O'Barker, Robert; Gibson, Andrew (Royal College Of Physicians, 2022-11)
  • Impact of the COVID-19 pandemic on public attitudes to cardiopulmonary resuscitation and publicly accessible defibrillator use in the UK

    Hawkes, Claire A.; Kander, Ines; Contreras, Abraham; Chen, Ji; Brown, Terry P.; Booth, Scott; Siriwardena, Aloysius; Fothergill, Rachael; Williams, Julia; Rees, Nigel; et al. (2022-06)
  • Recommendation for changes to the guidelines of trauma patients with potential spinal injury within a regional UK ambulance trust

    Cowley, Alan; Nelson, Magnus J.; Hall, Claire; Goodwin, Simon; Surendra Kumar, Dhushyanthan; Moore, Fionna (2022-12-01)
    Spinal assessment and immobilisation has been a topic of debate for many years where, despite an emerging evidence base and the delivery of new guidance overseas, little has changed within UK pre-hospital practice. Since 2018, South East Coast Ambulance Service NHS Foundation Trust has spent time working with local trauma networks and expertise from within the region and international colleagues to develop a set of C-spine assessment and immobilisation guidelines that reflect the current best available international evidence and significant changes in international pre-hospital practice from settings such as Scandinavia and Australasia. Abstract published with permission.

View more