• 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)
    • 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.
    • Attitudes to cardiopulmonary resuscitation and defibrillator use: a survey of UK adults in 2017

      Hawkes, Claire A.; Brown, Terry P.; Booth, Scott J.; Fothergill, Rachael T.; Siriwardena, Aloysius Niroshan; Zakaria, Sana; Askew, Sara; Williams, Julia; Rees, Nigel; Ji, Chen; et al. (2019-04)
    • Attitudes to CPR and public access defibrillation: A survey of the UK public

      Hawkes, Claire A.; Booth, Scott J.; Brown, Terry P.; Fothergill, Rachael T.; Zakaria, Sana; Askew, Sara; Siriwardena, Aloysius Niroshan; Williams, Julia; Rees, Nigel; Perkins, Gavin D. (2017-09)
    • Cooling of thermal burn injuries: a literature review

      Ashman, Harriet (2018-05)
      Abstract published with permission. Correct initial management of thermal burns is key in promoting patient outcomes. Cooling burns with cool running water (CRW) for 20 minutes has been shown to accelerate the wound healing process, improve cosmetic outcomes and prevent burn progression. This literature review aims to increase understanding of this simple first aid (FA) intervention, help inform paramedic practice, and determine areas for further research. Three themes came to light following systematic searching of the available literature. As a result of a paucity in evidence, a wide range of topics relating to cooling burns have been explored. The topics look at how patients and carers may approach FA in burns, how prehospital practitioners currently manage burns patients, and the best methods to use for cooling burns. Findings suggest that there is need for improved education for the lay public and pre-hospital providers in order to improve burn outcomes through FA interventions. While CRW is supported as a beneficial intervention, further research is required into alternative cooling methods to enhance care and evidence-based practice.
    • A critical review of NICE Guideline 39—major trauma: assessment and initial management

      Hodkinson, Mark (2016-05)
      Abstract published with permission. Major trauma is a leading cause of death in the under 40 years age group, and has a significant impact on morbidity, causing a financial burden to the National Health Service (National Audit Office, 2010). A recent guideline published by the National Institute for Health and Care Excellence (NICE, 2016a) seeks to address the recommendations made by a National Confidential Enquiry into Patient Outcome and Death (2007) and the National Audit Office (2010), therefore improving the standards of trauma care delivery across England. This article critically appraises the recommendations made by NICE (2016a), while considering the available evidence and the implications on pre-hospital major trauma care.
    • 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. (2015-05)
      Introduction Decisions made by ambulance staff are often timecritical and based on limited information. Wrong decisions could have serious consequences for patients but little is known about areas of risk associated with decisions about patient care. We aimed to examine system in fluences on decision making in the ambulance service setting focusing on paramedic roles. Method An exploratory mixed methods qualitative study was conducted in three Ambulance Service Trusts. A document search and 16 interviews were conducted to understand service delivery in each Trust, how they link with other services and potential influences on decisions about patient care. Researchers observed ambulance crews on 34 shifts and 10 paramedics completed ‘digital diaries’ to report challenges for decision making or patient safety. Three focus groups with staff (N=21) and three with service users (N=23) were held to explore their views on decision making and patient safety. Data were charted to produce a typology of decisions then coded and thematically analysed to identify in fluences on those decisions. Findings Nine types of decision were identi fied, ranging from specialist emergency pathways to non-conveyance. In fluences on these decisions included communication with Control Room staff; patient assessment, decision support and alternative options to ED conveyance. Seven main issues in fluencing patient safety in decision making were identi fied: meeting demand; performance and priorities; access to care options; risk aversion; education, training and professional development for crews; communication and feedback to crews; resources and safety culture. Conclusions A range of decisions are made by ambulance staff in complex, time bound changing conditions. Training and development and access to alternative options to ED conveyance were identi fied as particularly important issues. https://emj.bmj.com/content/emermed/32/5/e2.1.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-2015-204880.4
    • Defibrillation: standard vs. double sequential in adult out-of-hospital cardiac arrest

      Stevenson, Laura (2018-02)
      Abstract published with permission. Background: Refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest (OHCA) poses a significant challenge to paramedic teams and is further confounded by an absence of specific guidance on the management of this patient category. Objective: To conduct a systematic literature review to determine whether double sequential defibrillation (DSD) improves patient outcomes in adult OHCA. Methods: Electronic searches of CINAHL, MEDLINE and AMED databases were carried out, using EBSCOhost (2017) and a subsequent filtering process. Results: Three case series and two cohort studies provided the highest category of evidence to evaluate. DSD is offered as a potentially feasible RVF treatment strategy throughout. However, results are consistently limited by varying protocol and small study groups and DSD success is likely multifactorial. Conclusion: The current systematic literature review indicated that no confirmed association existed between DSD and improved OHCA outcomes. More robust research is required to eliminate profound limitations and consider contributing factors to DSD.
    • Do paramedics adequately restrain paediatric patients in road ambulances?

      Lockett, Stephanie; Edwards, Dale; Parker, Leigh (2017-01)
    • 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.
    • Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma: an observational study

      Prentice, Craig; Jeyanathan, Jeyasankar; De Coverly, Richard; Williams, Julia; Lyon, Richard M. (2018-09)
      https://bmjopen.bmj.com/content/bmjopen/8/9/e022464.full.pdf Objectives The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. Setting Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5million and a transient population of up to 8million people. Participants Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust’s geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected. Outcome measures Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates. Results 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the ‘not in TCA cohort’, 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-ofspontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital. Conclusion A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129099/pdf/bmjopen-2018-022464.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/bmjopen-2018-022464
    • 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
    • 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)