Recent Submissions

  • Comparison of manikin-based simulators and patient monitor simulators within paramedic education: the student perspective

    Mortimer, Craig (2017-12-14)
    Objective Investigate the impact to paramedic students of patient monitor simulators, when compared with manikin-based simulators within an educational programme. Design An exploratory study using an online questionnaire to gain qualitative and quantitative data. Setting One London university delivering a paramedic science programme. Participants A total of 136 paramedic students sponsored by a UK ambulance service were approached for this study. Data were received from 43 respondents (32%). Main outcome measures Comparison of simulators and their effect on student development through the identification of the student’s own perceived ability following use, perception of other’s ability (fellow students studying same course) following use and perception of the two pieces of simulation equipment available. Results The majority of respondents identified that simulation both increased their confidence and ability to demonstrate new knowledge and skills during simulation (97%) and further increased their ability to manage real patients (95%). Respondents agreed that there were advantages and disadvantages of using simulation, but these were not in line with those identified in previous studies. Instead of the human factors and non-technical skills outlined, students were much more practically focused on how the equipment performed. Conclusions This study suggests that there is a clear link between simulation and increased student confidence, but any issues encountered with the simulator equipment can reduce this benefit, causing the student’s learning environment to falter. Transitioning to monitor-based simulators is seen as a positive move, although the integration of manikins with this equipment is identified as being necessary. 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
  • What is the most appropriate out-of-hospital opioid for adults with traumatic pain?

    Ellis, Pierre (2017-12-06)
    Methods: The literature search was carried out using multiple databases to identify relevant out-of-hospital research with additional grey literature to support. The main themes encountered were intravenous morphine compared to intravenous fentanyl, and the contrast between them. Discussion: There were no significant differences in effectiveness or adverse effects. Intranasal application was thought to be favoured where intravenous access was unobtainable. Conclusions: Further research is required to establish which is the most appropriate opioid. This could include a greater focus on the onset time, duration and optimal dose. Increased education and organisational focus would need to be addressed alongside a change in drug formulary for the out-of-hospital clinician. Abstract published with permission.
  • Mixed methods in pre-hospital research: understanding complex clinical problems

    Whitley, Gregory Adam; Munro, Scott; Hemingway, Pippa; Law, Graham Richard; Siriwardena, Aloysius; Cooke, Debbie; Quinn, Tom (2020-12-01)
    Healthcare is becoming increasingly complex. The pre-hospital setting is no exception, especially when considering the unpredictable environment. To address complex clinical problems and improve quality of care for patients, researchers need to use innovative methods to create the necessary depth and breadth of knowledge. Quantitative approaches such as randomised controlled trials and observational (e.g. cross-sectional, case control, cohort) methods, along with qualitative approaches including interviews, focus groups and ethnography, have traditionally been used independently to gain understanding of clinical problems and how to address these. Both approaches, however, have drawbacks: quantitative methods focus on objective, numerical data and provide limited understanding of context, whereas qualitative methods explore more subjective aspects and provide perspective, but can be harder to demonstrate rigour. We argue that mixed methods research, where quantitative and qualitative methods are integrated, is an ideal solution to comprehensively understand complex clinical problems in the pre-hospital setting. The aim of this article is to discuss mixed methods in the field of pre-hospital research, highlight its strengths and limitations and provide examples. This article is tailored to clinicians and early career researchers and covers the basic aspects of mixed methods research. We conclude that mixed methods is a useful research design to help develop our understanding of complex clinical problems in the pre-hospital setting. Abstract published with permission.
  • Prehospital thrombolysis for STEMI where PPCI delays are unavoidable

    Lashwood, David (2020-09-07)
    Primary percutaneous coronary intervention (PPCI) is the gold standard for treating patients experiencing ST-elevation acute myocardial infarction (STEMI). More than 30 000 patients experience cardiac arrest out of a hospital setting in the UK every year and may be some distance from a PPCI facility. Aims: To analyse and consider if a better outcome could be achieved for patients if PPCI was an adjunct to thrombolytic therapy, where delays of ≥60 minutes are inevitable or unavoidable. Methods: The current review examined a range of articles, research materials and databases. Results: Some studies suggested the use of prehospital thrombolysis while others compared the effectiveness of drug-eluting stents. While the ‘gold standard’ for the treatment of patients experiencing a myocardial infarction is still PPCI, several factors can delay patients from receiving this treatment at an appropriate facility within the recommended time frame. Conclusion: Patients may not be able to access PPCI within 60, 90 or 120 minutes for reasons including increasing urbanisation, population growth and NHS hospital funding cuts. If the PPCI unit is some distance away, ambulance crews could start thrombolysis treatment and transmit clinical findings to a specialist cardiologist in the PPCI facility, or stop at a local hospital that could provide thrombolysis. Abstract published with permission.
  • The assessment and management of thermal burn injuries in a UK ambulance service: a clinical audit

    Ashman, Harriet; Rigg, Dean; Moore, Fionna (2020-12-01)
    Background: Although burn emergencies are infrequently encountered, the ambulance service is often the first point of contact for patients in these situations. It is therefore important that these potentially devastating injuries are managed in accordance with the evidence base. Appropriate assessment and management of these patients in the pre-hospital phase will have a significant impact upon their long-term outcomes, such as scarring cosmesis and functionality. Aim and objectives: This audit was conducted to determine if patients presenting to one UK ambulance service with thermal burn injuries were managed safely, effectively and in a timely manner. Areas highlighted for improvement will assist in directing future pre-hospital research and educational requirements. Epidemiological data will also be provided. Results: 278 thermal burn incidents occurring from June 2017 to May 2018 (inclusive) were included in this audit. A larger proportion of burn patients were paediatrics who fell into the 0-10 age category, most burn patients were injured at a home address and only nine of the overall sample were major burns. Only 35% of patients received adequate cooling of their burns, an essential first aid intervention. The assessment of pain (87%) and provision of analgesia (75%) showed a higher compliance rate. However, only 54% had pain reassessed after analgesia. There was a near 100% compliance rate for patients being managed without hydrogel dressings and topical medicines. Conclusion: The results indicate several areas for improvement within the ambulance trust. Of importance is the application of basic first aid, such as cooling. It is important not only to improve education among staff but also to understand non-compliance. It should be acknowledged that assessment of pain and provision of analgesia demonstrated far higher compliance compared to current pre-hospital evidence. Several points for education and research have been identified. Abstract published with permission.
  • Hub-and-spoke model for thrombectomy service in UK NHS practice

    Zhang, Liqun; Ogunbemi, Ayokunle; Trippier, Sarah; Clarke, Brian; Khan, Usman; Hall, Claire; Ji, Qiuhong; Clifton, Andrew; Cluckie, Gillian (2021-01)
  • Basics in advanced life support: A role for download audit and metronomes

    Fletcher, David; Galloway, Robert; Chamberlain, Douglas; Pateman, Jane; Bryant, Geoffrey; Newcombe, Robert G. (2008-08-01)
  • Student paramedic decision-making: a critical exploration of a patient interaction

    Costello, Barry; Downs, Simon (2021-02)
    Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction. Abstract published with permission.
  • Does a paramedic practitioner self-tasking dispatch model benefit their self-sufficiency in patient management? A cross sectional study

    Cotterill, Liam; Halter, Mary (2020-10)
    Paramedic Practitioner (PP) scope of practice is not comprehensively understood by Emergency Operations Centre (EOC) staff and tasking may be suboptimal. In one UK ambulance trust in November 2018, one PP team was enabled to remotely monitor live incidents and, alongside some continued EOC-dispatch, to self-task to incidents they judged would benefit from their additional knowledge and skills. Evidence on self-tasking benefit was found from helicopter emergency services only. 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. DOI
  • Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project.

    Steel, Alistair; Haldane, Charlotte; Cody, Dan (2021-02-15)
    Advanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting. 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. DOI
  • A national survey of ambulance paramedics on the identification of patients with end of life care needs

    Eaton-Williams, Peter; Barrett, Jack; Mortimer, Craig; Williams, Julia (2020-12-01)
    Objectives: Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. Methods: Between 4 November 2019 and 5 January 2020, registered paramedics from nine English NHS ambulance service trusts were invited to complete an online questionnaire. The questionnaire initially explored current practice and awareness, employing multiple-choice questions. The Gold Standards Framework Proactive Identification Guidance (GSF PIG) was then presented as an example of EoLC assessment guidance, and further questions, permitting freetext responses, explored attitudes towards performing this role. Results: 1643 questionnaires were analysed. Most participants (79.9%; n = 1313) perceived that they attended a patient who was unrecognised as within the last year of life on at least a monthly basis. Despite 72.0% (n = 1183) of paramedics indicating that they had previously made an EoLC referral to a General Practitioner, only 30.5% (n = 501) were familiar with the GSF PIG and of those only 25.9% (n = 130) had received training in its use. Participants overwhelmingly believed that they could (94.4%; n = 1551) and should (97.0%; n = 1594) perform this role, yet current barriers were identified as the inaccessibility of a patient’s medical records, inadequate EoLC education and communication difficulties. Consequently, facilitators to performing this role were identified as the provision of training in EoLC assessment guidance and establishing accessible, responsive EoLC referral pathways. Abstract published with permission.
  • A retrospective review of patients with significant traumatic brain injury transported by emergency medical services within the south east of England

    Barrett, Jack (2019-03)
    Traumatic brain injury (TBI) will be a leading cause of death and disability within the Western world by 2020. Currently, 80% of all TBI patients in England are transported to hospital by an ambulance service. The aim of this retrospective study is to compare TBI patients transported to a major trauma centre (MTC) against those transported to a trauma unit (TU). Abstract published with permission.
  • Ambulance clinicians’ perspectives of sharing patient information electronically

    Barrett, Jack (2019-12)
    Communication in the NHS is vital to patient care and safety. Government bodies are pushing for the digitisation of patient health records so that access and transfer of information is easier between patient care teams. Many ambulance trusts have issued their clinical staff tablet computers as a step in the transition from paper-based to electronic-based patient health records. This study aims to evaluate whether these ambulance clinicians perceive tangible benefits to digitisation, particularly regarding collaborative working with other healthcare professionals. Abstract published with permission.
  • Where's the Fire?

    Copson, Anne (2008-12)
    As the UK explores the potential for fire services to act as first-responders to medical incidents, it is interesting that this research focuses on a system where fire services have traditionally been utilized as first-responders and where questions are now being asked as to whether this resource is appropriate for all emergency health care calls. The study included a ‘before-after’ design and set out to examine whether a selective emergency medical dispatch (EMD) system could reduce the frequency of deployment of fire department first-responder units and, if it did, whether this compromised patient safety. Abstract published with permission.
  • Paramedic management of shock in trauma: unlocking the potential

    Hitt, Andy (2010-08)
    Globally, traumatic injury is a leading cause of death for patients under 45 years old. A consequence of serious or poorly managed trauma is shock—a clinical syndrome that is both preventable and treatable if spotted in time. Heightened pathophysiological awareness and a review of diagnostic methods may promote early circulatory support rather than aggressive resuscitation. This could reduce the risk of iatrogenic complications and avoid unnecessary delay. The aim of this article is to critically appraise the treatment options currently available to UK paramedics and postulate realistic improvements based on underlying pathophysiology. Abstract published with permission.
  • Acute stroke life support: a United States based training course; is it appropriate for and transferable to the English health care setting?

    Davis, David; Crook, D.; Hargroves, D.; Miller, G.; South, A.; Jenkinson, D.; Smithard, D. (2009-12-01)
  • A Study to Assess the Use of Pre-Hospital Charcoal in South East England

    Dines, A. M.; Butler, C.; Taylor, I.; Ovaska, H.; Rowland, A.; Wood, D. M.; Dargan, Prinkeet (2009-06-03)
  • Vehicles and equipment for land-based neonatal transport

    Kempley, S. T.; Ratnavel, Nandiran; Fellows, T. (2009-08)
  • Phase shift in transmitted electrocardiograms: A cautionary tale of distorted signals

    Tayler, David; Hitt, Andy; Jolley, Brian; Sanders, Guy; Chamberlain, Douglas (2009-08-01)

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