Recent Submissions

  • Enhancing mental health resilience and anticipating treatment provisions of mental health conditions for frontline Healthcare workers involved in caring for patients during the COVID-19 Pandemic - A call for action

    Kullu, Cecil; Coley, Andrew; Cooper, Cary; Aitken, John; Cummings, Jane; Gerada, Clare; Grant, Chris; Rafferty, Joe; Kumar, Raj; Gizzi, Denis; et al. (2020)
  • Effective clinical feedback provision to ambulance clinicians: a literature review

    Eaton-Williams, Peter; Mold, Freda; Magnusson, Carin (2020-03-12)
    Background Clinical feedback provision to health professionals is advocated to benefit both clinical development and work engagement. Aim This literature review aims to develop recommendations for effective clinical feedback provision by examining mechanisms that exist specifically for ambulance clinicians. Method: A systematic search of contemporary literature identified 15 research papers and four articles, which were included for review and narrative synthesis. Findings The initial identification of practice that requires improvement, together with an understanding of the practitioners' baseline attitudes, is important. While minimising resource demands will improve sustainability, repeated interaction with clinicians will benefit effectiveness. Provision should be balanced and timely, and who delivers feedback is significant. Clinical outcome feedback not restricted to specific conditions requires further consideration of which incidents will initiate feedback and what information will be supplied. Conclusion Feedback has been shown to improve clinical performance but demonstrating subsequent benefits to patient outcomes has proved more difficult. Abstract published with permission.
  • Prehospital amputation: a scoping review

    Gander, Bradley (2020-01)
    Abstract published with permission. Background: Where limbs or extremities become entrapped and it is not possible to extricate a patient in time to prevent death, or because of a deterioration or scene safety emergency, prehospital amputation is an option to enable extrication. Aims: This study aimed to analyse accounts of prehospital amputation and identify factors that may influence practice as well as areas for further research. Methods: A search of multiple databases (AMED, BNI, CINAHL, EMCARE, Google Scholar and PubMed) and additional literature for accounts of prehospital amputation was carried out. Results: Thirteen sources of evidence describing 20 cases of prehospital amputation (18) or dismemberment (2) in a variety of settings between 1975 and 2019 were identified. Prehospital amputation was reported following structural collapse (8), industrial accidents (6), road traffic crashes (5) and rail incidents (1). The procedure was undertaken for a range of reasons, including unsuccessful traditional extrication attempts (7), time-critical patient condition (6), a risk of further extrication attempts causing structural destabilisation (5) and dismemberment of deceased victims (2). The equipment used to perform the amputation was not reported in 14 cases. Outcomes were reported in 17 accounts, with all patients surviving to hospital. Conclusion: Prehospital amputation is performed extremely rarely and accounts in the literature are limited. The situations and environments in which prehospital amputation is reported vary and specialist teams are often required. Further review of guidance and studies on techniques may be beneficial.
  • Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals

    Fletcher, David; Chamberlain, Douglas; Handley, Anthony; Woollard, Malcolm; Pateman, Jane; Nela, Svetlana; Bryant, Geoffrey (2011-10)
  • The seizurogenecity of naloxone in tramadol overdose

    Cowley, Alan (2012-05)
    Abstract published with permission. Tramadol is the most widely prescribed opiate analgesic (National Treatment Agency for Substance Misuse, 2011) and, as a result, is present in a large number of overdoses that present in the pre-hospital arena. Naloxone is indicated for use by ambulance personnel where the GCS is reduced due to a known, or possible, overdose of an opiate containing substance (JRCALC (Joint Royal Colleges Service Liaison Committee), 2006). A case study of a tramadol overdose shows a close temporal relationship between naloxone administration and a seizure. While seizure is a symptom of tramadol intoxication (Saidi et al, 2008), the speed with which it occurred after naloxone administration seemed too fast to be merely coincidence. A study of the literature shows evidence that naloxone can instigate seizure in the case of a tramadol overdose (Rehni et al, 2008; Raffa and Stone, 2008). This information is particularly pertinent to the ambulance clinician as the consequence of a seizure can be important, both practically and clinically. The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose.
  • PP19 Use and impact of the pre-hospital 12-lead electrocardiogram in the primary PCI era (PHECG2): mixed methods study protocol

    Munro, Scott; Gavalova, Lucia; Halter, Mary; Snooks, Helen; Gale, Chris P.; Weston, Clive; Watkins, Alan; Davies, Glenn; Hampton, Chelsey; Driscoll, Timothy; et al. (2019-09-24)
    Background The pre-hospital 12-lead electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found PHECG was associated with improved 30-day survival, but a third of ACS patients under EMS care did not have PHECG. Such patients tended to be female, older and/or with comorbidities. This previous study was undertaken when thrombolytic treatment was the main treatment for ST segment elevation myocardial infarction (STEMI); practice has since shifted to a predominant interventional strategy – primary percutaneous coronary intervention (pPCI). Moreover, the previous study relied solely on data collected by the Myocardial Ischaemia National Audit Project (MINAP), which does not include information on symptoms, EMS personnel gender, and other factors that may influence decision-making. The PHECG2 study addresses the following research questions: a) Is there a difference in 30-day mortality and reperfusion between those who do and do not receive PHECG? b) Has the proportion of eligible patients who receive PHECG changed since the introduction of pPCI networks? c) Are patients that receive PHECG different from those that do not in social and demographic factors, and in pre-hospital clinical presentation? d) What factors do EMS clinicians report as influencing their decision to perform PHECG? Methods Explanatory sequential Quan-Qual mixed methods study comprising 4 Work Packages (WPs): WP1 a population based, linked data analysis of MINAP from 2010–2017 (n=510,000); WP2 retrospective chart review of EMS records from 3 EMS; WP3 focus groups with personnel from 3 EMS. WP4 will synthesise findings from WP1-3. Conclusions Gaining an understanding into the clinical and non-clinical factors influencing EMS clinicians’ decisions to record PHECG will enable us to develop (and later test through a randomised trial) an intervention to improve PHECG uptake and patient outcomes following an ACS event., 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
  • Oxygen titration therapy and hypercapnia risk in COPD

    Harding, Cecily; Hart, Lindsay (2019-09-11)
    Background: Estimated to be the third leading cause of death in the UK by 2030, chronic obstructive pulmonary disease (COPD) is a common presenting complaint requiring an emergency ambulance. It is recognised that patients with COPD are at high risk of developing hypercapnia with the main theory of causality being high-flow oxygen therapy. Therefore, current guidelines recommend titrating oxygen therapy to maintain oxygen saturation percentage (SpO2) of 88–92% to reduce this risk. Aim: The aim of this review is to analyse literature concerning oxygen therapy in patients with COPD and their potential risk of hypercapnia. Methods: Extensive literature searches with strict parameters were carried out in electronic databases. After filtration of results, eight core articles were selected for analysis, from which three themes were identified as particular topics of interest. Findings: Critical analysis of the core articles confirmed the increased risk of hypercapnia in patients with COPD, but it is unclear if the cause is high-flow oxygen therapy, rate of alveolar ventilation or a specific COPD phenotype. Conclusion: Methods of reducing hypercapnia are limited in the prehospital setting with the only method transferable to paramedic practice being air nebulisation. Clinical compliance with study protocols and current national guidelines is low, both in prehospital and in-hospital environments. Abstract published with permission.
  • The impact of paramedic shift work on the family system: a literature review

    Anderson, Lucy (2019-08-07)
    Aim: The current review investigates the impacts of paramedic work on the family system. Paramedics are taking time off or leaving through stress, and career decisions could be influenced by this perceived impact. Method: A systematic literature review was conducted and the literature critiqued. Two themes were identified: emotional labour and work-family fit. Results: Paramedics rely on families for emotional support, putting them at risk of vicarious trauma. The historical male coping culture of paramedic practice deters processing at work, detrimentally carrying this processing into the home environment. Additionally, several shift characteristics contribute to work-family conflict, child-rearing conflict and difficulties maintaining a social life. Conclusions: Key organisational culture change is needed from denigrating staff for showing emotions and struggling to find work-life balance, to one that improves experiences at work and therefore at home as well. Recent movement towards almost equal gender balance may present a particular opportunity to deliver culture change. Further research is required to better understand the impact that shift work has on the family. Abstract published with permission.
  • Single patient use versus reusable laryngeal mask airways: a comparison

    Hodkinson, Mark (2013-10)
    Abstract published with permission. The laryngeal mask airway was first developed in the 1980s by Dr Archie Brain. The market for supraglottic airways has rapidly expanded since the 1980s, incorporating both reusable and single patient use devices, varying in design, application, cost and durability. Here, the author considers theoretical and anecdotal evidence when comparing single patient use and reusable supraglottic airways. Particular attention has been drawn to the I-Gel, pro-seal laryngeal mask airway and conventional laryngeal mask airway.
  • Videoscopes: an additional tool for managing the pre-hospital airway

    Hodkinson, Mark (2013-09)
    Abstract published with permission. Airway management by pre-hospital care providers is often the subject of intense debate. It is recognised that there are wide variations in clinical training and skill fade is high among paramedics due to lack of experience and exposure (Hodkinson, 2010). Recent years have seen the development of a wide variety of video based laryngoscope devices, several of which have potential application to the pre-hospital field. There are a number of advantages and disadvantages to these devices, which are explored in more detail. Prior to any recommendations being made, further research including clinical trials would be required in the pre-hospital field, to assess the suitability of videoscope devices for paramedic airway management.
  • Understanding the process and treatment of meningitis and meningococcal disease

    Hodkinson, Mark (2013-05)
    Abstract published with permission. Meningococcal septicaemia is a potentially life-threatening disease process which requires early recognition and rapid management in both pre-hospital and hospital phases of patient care. It is estimated that there are around 3 500 confirmed cases annually in the United Kingdom and, as such, widespread campaigns and national guidelines have been developed and adopted throughout NHS trusts. Standard treatment protocols have been developed and adopted to manage patients appropriately; however, other emerging treatment options are becoming more widely acknowledged, but require further investigation before recommendations can be made. It is vitally important that clinicians in patient-facing roles who are likely to come into contact with meningococcal-related diseases adopt a high index of suspicion, basing diagnosis on history, physical examination and clinical investigations. Rapid intervention should be undertaken for any patient where the disease process is suspected.
  • Protocol C: a nonguidelines - compliant approach to improve survival of patients with out-of-hospital cardiac arrest

    Chamberlain, Douglas; Fletcher, David; Woollard, Malcolm; Handley, Anthony (2012-06)
  • Intranasal and buccal midazolam in the pre-hospital management of epileptic tonic-clonic seizures

    Thom, David (2014-08)
    Abstract published with permission. Epilepsy is a common neurological condition causing seizures or convulsions. This article looks to analyse the treatment and management of a patient suffering from a prolonged epileptic tonic-clonic seizure by the administration of two common benzodiazepines: midazolam and diazepam. Epileptic seizures carry high risks of secondary injury and the potential for long-term neurological damage; therefore, it is imperative that paramedics can provide swift and effective treatment for these patients. With current advances in pre-hospital care, paramedics should be aware of the latest advances in techniques, management and the associated legal issues. This article will look specifically at the administration of benzodiazepines and in particular the comparison between midazolam and diazepam and the routes of administration available.

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