• 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)
    • Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT

      Perkins, Gavin; Ji, Chen; Achana, Felix; Black, John J.M.; Charlton, Karl; Crawford, James; de Paeztron, Adam; Deakin, Charles; Docherty, Mark; Finn, Judith; et al. (2021-04)
    • 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.
    • The ambulance service: what it ought to be

      Chamberlain, Douglas (2016-12)
    • 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.
    • 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; Fothergill, Rachael; Siriwardena, Aloysius; 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; Brown, Terry P.; Fothergill, Rachael; Zakaria, Sana; Askew, Sara; Siriwardena, Aloysius; Williams, Julia; Rees, Nigel; Perkins, Gavin D. (2017-09)
    • 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)
    • 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. https://stel.bmj.com/content/4/2/65. 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/ DOI http://dx.doi.org/10.1136/bmjstel-2017-000252
    • 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)