• The ambulance service: what it ought to be

      Chamberlain, Douglas (2016-12)
    • Asthma, infection and the World Anti-Doping Agency: a case study

      Thom, David (2017-05)
      Abstract published with permission. Paramedics are now encountering ever more complex medical situations, and are expected to formulate holistic management plans. This case provides an interesting scenario whereby management was considered not only in conjunction with current evidence and guidelines but also with patient preference. This article will explore the assessment and management of a patient presenting with asthma and a chest infection whilst considering legal, ethical and professional factors.
    • Do paramedics adequately restrain paediatric patients in road ambulances?

      Lockett, Stephanie; Edwards, Dale; Parker, Leigh (2017-01)
    • 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. https://emj.bmj.com/content/37/10/e11.2 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.24
    • Independent prescribing: a journey to provide the best possible care

      Sharman, Andy (2015-05)
      Abstract published with permission. Many patients benefit, and will continue to benefit, as a result of paramedics being able to administer medicines under standards set by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence, regarding the use of patient group directions (PGDs), patient specific directions (PSDs) and exemptions. It is not uncommon, however, for these mechanisms to prove ineffective. This can result in delays for patients receiving the care that is best suited to their individual needs. This article looks at how independent prescribing by paramedics would allow patients to receive the care and medicines they need, resulting in a far greater number of patients benefiting from improved and more timely care and greater convenience.
    • 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.
    • Paramedic practitioners

      Walter, Alex (2014-02)
    • Perceived areas for future intervention and research addressing conveyance decisions and potential threats to patient safety: stakeholder workshops

      O'Hara, Rachel; Johnson, Maxine; Hirst, Enid; Weyman, Andrew; Shaw, Deborah; Mortimer, Peter; Newman, Chris; Storey, Matthew; Turner, Janette; Mason, Suzanne; et al. (2016-09)
      Background As part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention. Methods A total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample. Findings The two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety. Conclusions Feedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda. https://emj.bmj.com/content/emermed/33/9/e7.3.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-2016-206139.25
    • A qualitative study of decision-making and safety in ambulance service transitions

      O'Hara, Rachel; Johnson, Maxine; Hirst, Enid; Weyman, Andrew; Shaw, Deborah; Mortimer, Peter; Newman, Chris; Storey, Matthew; Turner, Janette; Mason, Suzanne; et al. (2014-12)
    • What can dyslexic paramedic students teach us about mentoring? A case study

      Lavender, Rachael J.B. (2017-05)
      Abstract published with permission. The context or background for the study: this paper was written following a critical analysis and structured reflection on mentoring and teaching a dyslexic paramedic student including approaching from personal experience as well as identifying a gap in research. The purpose of this study was to discover what paramedic mentors can do to improve their interactions with dyslexic stu-dents. Basic procedures: following the experience of teaching one student, to work on this definition of dyslexia: "difficulties in processing, particularly literacy and the acquisition of reading, writing and spelling’." Using an analytical method – qualitative and reflective. Main findings: inclusive learning helps to fight stigma while improving education for all whether they dis-close dyslexia or not. There are many steps that can be taken by mentors to support stu-dents, including allowing time to think/to practise and support with organising. Conclusions: inclusive learning benefits all students, not just students with dyslexia. Students do not legally have to disclose a dyslexia diagnosis, so, introducing inclusive learning for all students using accessible and practical learning could benefit more students.