• Do paramedics adequately restrain paediatric patients in road ambulances?

      Lockett, Stephanie; Edwards, Dale; Parker, Leigh (2017-01)
    • Emergency medical dispatch: do the dead take priority over the dying?

      Hitt, Andy; Williams, Julia; Edwards, Timothy (2015-05)
      Background In the UK demand for emergency ambulances is increasing. To deal with this increase, Ambulance Service Trusts must use resources effectively and ensure that they are deployed appropriately. Aim The aim of this study was to gain an understanding of factors in fluencing resource dispatchers ’ (RD) decision-making processes when managing ambulance resources attending out-of-hospital cardiac arrest (OOHCA) and how these decisions might impact on resource availability. Method Utilising a generic qualitative approach, nine RDs participated in semi structured interviews which were recorded and transcribed verbatim. Data analysis was performed using a template style of thematic analysis. Findings OOHCA generally takes priority over other emergency calls regardless of clinical need or likely prognosis. Participants stated that they would probably drive past a critically ill patient to attend a patient in cardiac arrest even if they believed them to be beyond help. A significant amount of time was spent dealing with deceased patients, especially when waiting for police to attend. This may affect resource availability and subsequently delay treatment of other critically ill and injured patients. Limitations Dispatching processes may differ between Trusts so further studies are required to enhance transferability of findings. Conclusions OOHCA is almost always prioritised above other time critical emergencies despite the view that other patients may bene fit more from a priority response. Decisions are made rapidly, under pressure and with very little clinical information to hand. Recommendations for change Further research is required before substantive recommendations can be made but preliminary indications infer that resource efficiency may be improved by applying simple changes to every day practice including dialogue between lead clinician and dispatcher to optimise staff skill mix in attendance to calls and improved liaison between police and ambulance controls to facilitate the prompt stand down of ambulance resources dealing with deceased patients. https://emj.bmj.com/content/emermed/32/5/e4.3.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-2015-204880.12
    • Paramedic accuracy and confidence with a trauma triage algorithm: a cross-sectional survey

      Durham, Mark (2017-03)
      Abstract published with permission. Introduction – Since 2008, the UK has been developing trauma networks, with ambulance services adopting triage tools to support these. So far there has been no published work on how UK paramedics use these algorithms. This study aims to evaluate factors affecting the accuracy and self-perceived confidence of paramedics from one UK Ambulance Trust when applying the Major Trauma Decision Tree. Methods – A quantitative cross-sectional survey was e-mailed to every paramedic within the participating Ambulance Trust, asking for basic demographic data and presenting four case studies. Respondents applied the Major Trauma Decision Tree to the case studies, stating which algorithm steps (if any) they triggered, and their appropriate destination. A Likert scale was utilised to explore respondent views on the Major Trauma Decision Tree. Descriptive and inferential statistics were used to identify linked factors affecting accuracy/confidence. Results – Of the 1132 paramedics employed by the Trust, 178 completed the survey (16% response rate). Sensitivity with the Major Trauma Decision Tree was 77% (95% CI 72–81%) and specificity, 61% (95% CI 56–66%). The trigger most commonly missed was patient age of greater than 55 years. Respondents reported that transport time to a major trauma centre/trauma unit influenced compliance with the algorithm. Self-perceived confidence was low overall, but correlated positively with frequency of exposure to trauma (rs [178] = 0.323, p < 0.0005). Respondents’ concerns about the reception they would encounter from hospital staff correlated negatively with confidence (rs [178] = –0.459, p < 0.0005). Conclusion – Respondent sensitivity when using the Major Trauma Decision Tree was low, which may be due to paramedic concerns about transport time. The most commonly missed trigger was patient age. Future training may benefit from addressing these points. In addition, respondents’ confidence with the Major Trauma Decision Tree was also low and closely linked with exposure to trauma, and the reception anticipated from hospital staff.
    • UK ambulance services: collaborating to provide good end-of-life care

      Stead, Sarah; Datta, Shirmilla; Hill, James; Smith, Richard; Nicell, Claire (2018-05)
    • Understanding variation in ambulance service non-conveyance rates: a mixed methods study

      O'Cathain, Alicia; Knowles, Emma; Bishop-Edwards, Lindsey; Coster, Joanne; Crum, Annabel; Jacques, Richard; james, cathryn; Lawson, Rod; Marsh, Maggie; O'Hara, Rachel; et al. (2018-06)
    • ‘You're never making just one decision’: exploring the lived experiences of ambulance Emergency Operations Centre personnel

      Coxon, Astrid; Cropley, Mark; Schofield, Pat; Start, Kath; Horsfield, Claire; Quinn, Tom (2016-09)
      Background The aim of this study was to explore the experiences of ambulance dispatch personnel, identifying key stressors and their impact on staff well-being. Methods Qualitative methodology was used. Nine semistructured interviews were conducted with National Health Service (NHS) ambulance Emergency Operations Centre (EOC) dispatch personnel in the UK between July and August 2014. Participants were asked about their experiences of the role, stress experienced and current strategies they use to deal with stress. Transcripts were analysed using an inductive, bottom-up thematic analysis. Results Three key themes were identified: (1) ‘How dispatch is perceived by others’, (2) ‘What dispatch really involves’ and (3) ‘Dealing with the stresses of dispatch’. All participants expressed pride in their work, but felt overloaded by the workload and undervalued by others. Several sources of additional stress, not directly related to the execution of their work, were identified, including the need to mentally unwind from work at the end of a shift. Participants were able to identify a number of ways in which they currently manage work-related stress, but they also suggested changes the organisation could put in place in order to reduce stress in the working environment. Conclusions Building on existing theory on work stress and postwork recovery, it was concluded that EOC dispatch staff require greater support at work, including skills training to promote postshift recovery, in order to reduce the likelihood of sickness absence, and prevent work-related fatigue. https://emj.bmj.com/content/emermed/33/9/645.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-2015-204841