• Fit to practise: does more need to be done to improve the health and wellbeing of paramedics?

      Barrett, Jack (2016-10)
      Abstract published with permission. Paramedics are exposed to both physiological and psychological stressors that the general population does not typically face. Although there is evidence to show that paramedics can be resilient to these, cardiovascular disease, mental health problems and musculoskeletal injuries are still prevalent among paramedics. Exercise has been shown to reduce the physical demands of lifting for paramedics, but data on the effects in other areas of paramedic life are limited. In the general population, exercise is becoming a popular treatment option for mental health problems. However, the methodologies used are inconsistent and it is difficult to draw definitive conclusions from the data available. A more thorough examination of how regular exercise could positively impact the health and well-being of paramedics, who are key, front-line personnel in the medical services, is an area that requires crucial further research.
    • Helicopter emergency medical service dispatch in older trauma: time to reconsider the trigger?

      Griggs, J.E.; Barrett, J.W.; Ter Avest, E.; de Coverly, R.; Nelson, M.; Williams, J.; Lyons, R.M. (2021-05-07)
    • Hub-and-spoke model for thrombectomy service in UK NHS practice

      Zhang, Liqun; Ogunbemi, Ayokunle; Trippier, Sarah; Clarke, Brian; Khan, Usman; Hall, Claire; Ji, Qiuhong; Clifton, Andrew; Cluckie, Gillian (2021-01)
    • 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.
    • Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project.

      Steel, Alistair; Haldane, Charlotte; Cody, Dan (2021-02-15)
      Advanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting. https://emj.bmj.com/content/early/2021/02/14/emermed-2020-209944 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-2020-209944
    • 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.
    • Intra-cardiac arrest thrombolysis in the pre-hospital setting: four cases worth considering

      Hitt, Andy; Pateman, Jane (2015-01)
      Abstract published with permission. Background: It has been estimated that over 400 000 people have an outof-hospital cardiac arrest (OHCA) annually in the United States and Europe combined, of whom fewer than 10% survive to hospital discharge. In up to 70% of cases OHCA is caused by underlying acute coronary disease or pulmonary embolism, and as such the benefits of thrombolytic therapy during resuscitation attempts have been explored without there being a clear conclusion. This paper presents a case series of four victims of OHCA who received thrombolysis, with adjunctive antithrombotic therapy, in the pre-hospital phase of their treatment. Three of these were attended by a critical care paramedic (CCP)—a paramedic with advanced training in emergency care—who received online physician support. The other victim was attended by paramedics and a physician who is experienced in pre-hospital emergency care. Discussion: Although there is much debate about the efficacy of routine administration of thrombolytic therapy during OHCA, cases such as those featured in this paper indicate a need for clinicians to consider the merits of prehospital thrombolysis (PHT) based on individual patient characteristics and the circumstances leading to their presenting condition. Conclusions: Lives can be saved with the timely administration of intra-arrest PHT but candidates should be selected with great care. This may be best delivered in systems where clinicians at scene are supported by expert medical advice, allowing clinicians to recognise and treat this small but important group of survivors.
    • 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.
    • Live video footage from scene to aid helicopter emergency medical service dispatch: a feasibility study

      ter Avest, E.; Lambert, E.; De Coverly, Richard; Tucker, H.; Griggs, J.; Wilson, Mark H.; Williams, Julia; Lyon, Richard M.; Ghorbangholi, A. (2019-05)
    • Mixed methods in pre-hospital research: understanding complex clinical problems

      Whitley, Gregory; Munro, Scott; Hemingway, Pippa; Law, Graham Richard; Siriwardena, Aloysius; Cooke, Debbie; Quinn, Tom (2020-12-01)
      Healthcare is becoming increasingly complex. The pre-hospital setting is no exception, especially when considering the unpredictable environment. To address complex clinical problems and improve quality of care for patients, researchers need to use innovative methods to create the necessary depth and breadth of knowledge. Quantitative approaches such as randomised controlled trials and observational (e.g. cross-sectional, case control, cohort) methods, along with qualitative approaches including interviews, focus groups and ethnography, have traditionally been used independently to gain understanding of clinical problems and how to address these. Both approaches, however, have drawbacks: quantitative methods focus on objective, numerical data and provide limited understanding of context, whereas qualitative methods explore more subjective aspects and provide perspective, but can be harder to demonstrate rigour. We argue that mixed methods research, where quantitative and qualitative methods are integrated, is an ideal solution to comprehensively understand complex clinical problems in the pre-hospital setting. The aim of this article is to discuss mixed methods in the field of pre-hospital research, highlight its strengths and limitations and provide examples. This article is tailored to clinicians and early career researchers and covers the basic aspects of mixed methods research. We conclude that mixed methods is a useful research design to help develop our understanding of complex clinical problems in the pre-hospital setting. Abstract published with permission.
    • A national survey of ambulance paramedics on the identification of patients with end of life care needs

      Eaton-Williams, Peter; Barrett, Jack; Mortimer, Craig; Williams, Julia (2020-12-01)
      Objectives: Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. Methods: Between 4 November 2019 and 5 January 2020, registered paramedics from nine English NHS ambulance service trusts were invited to complete an online questionnaire. The questionnaire initially explored current practice and awareness, employing multiple-choice questions. The Gold Standards Framework Proactive Identification Guidance (GSF PIG) was then presented as an example of EoLC assessment guidance, and further questions, permitting freetext responses, explored attitudes towards performing this role. Results: 1643 questionnaires were analysed. Most participants (79.9%; n = 1313) perceived that they attended a patient who was unrecognised as within the last year of life on at least a monthly basis. Despite 72.0% (n = 1183) of paramedics indicating that they had previously made an EoLC referral to a General Practitioner, only 30.5% (n = 501) were familiar with the GSF PIG and of those only 25.9% (n = 130) had received training in its use. Participants overwhelmingly believed that they could (94.4%; n = 1551) and should (97.0%; n = 1594) perform this role, yet current barriers were identified as the inaccessibility of a patient’s medical records, inadequate EoLC education and communication difficulties. Consequently, facilitators to performing this role were identified as the provision of training in EoLC assessment guidance and establishing accessible, responsive EoLC referral pathways. Abstract published with permission.
    • A national survey of ambulance paramedics on the identification of patients with end of life care needs

      Eaton-Williams, Peter; Barrett, Jack; Mortimer, Craig; Williams, Julia (2021-03)
      Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. Abstract published with permission.
    • A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

      Munro, Scott F.S.; Joy, Mark; de Coverly, Richard; Salmon, Mark; Williams, Julia; Lyon, Richard M. (2018-09)
    • 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.