• The seizurogenecity of naloxone in tramadol overdose

      Cowley, Alan (2012-05)
      Abstract published with permission. Tramadol is the most widely prescribed opiate analgesic (National Treatment Agency for Substance Misuse, 2011) and, as a result, is present in a large number of overdoses that present in the pre-hospital arena. Naloxone is indicated for use by ambulance personnel where the GCS is reduced due to a known, or possible, overdose of an opiate containing substance (JRCALC (Joint Royal Colleges Service Liaison Committee), 2006). A case study of a tramadol overdose shows a close temporal relationship between naloxone administration and a seizure. While seizure is a symptom of tramadol intoxication (Saidi et al, 2008), the speed with which it occurred after naloxone administration seemed too fast to be merely coincidence. A study of the literature shows evidence that naloxone can instigate seizure in the case of a tramadol overdose (Rehni et al, 2008; Raffa and Stone, 2008). This information is particularly pertinent to the ambulance clinician as the consequence of a seizure can be important, both practically and clinically. The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose.
    • Single patient use versus reusable laryngeal mask airways: a comparison

      Hodkinson, Mark (2013-10)
      Abstract published with permission. The laryngeal mask airway was first developed in the 1980s by Dr Archie Brain. The market for supraglottic airways has rapidly expanded since the 1980s, incorporating both reusable and single patient use devices, varying in design, application, cost and durability. Here, the author considers theoretical and anecdotal evidence when comparing single patient use and reusable supraglottic airways. Particular attention has been drawn to the I-Gel, pro-seal laryngeal mask airway and conventional laryngeal mask airway.
    • Stocklist — a study of clinical skills of critical care paramedics in the UK

      Walmsley, Jim; Turner, Janette (2015-05)
      Introduction The Critical Care Paramedic (CCP) is a relatively new advanced practitioner. CCPs provide advanced clinical skills, knowledge and expertise for primary response and critical care retrieval and transfer. In the UK it is currently an undefined role with no common code of practice, clinical governance or national guidance. The aim of this study was to explore the current use of CCPs and assess the views of a range of stakeholders on the required skills and role development within a British context. Methods A web based survey design was used to collect information on CCP use and views on skills, role and scope of practice. The survey asked questions on current or intended use of CCPs and skills used. Respondents were asked to rate a list of 23 clinical skills on whether they were essential, desirable or irrelevant; importance of a set of standards and statements about the role of CCPs in the ambulance service. Stakeholders approached included ambulance services, professional bodies, charitable organisations and academic departments. Results From 198 invitations there were 141 responses (70%) and 70% were from ambulance trusts. Half of responders said they currently used CCPs. The top 5 essential skills were concerned with airway management. Views on core standards and the CCP role are summarised in the table. Conclusions The survey confirmed the CCP role is currently undefined and used variably in practice. There was agreement on the need for core skills and standards but the nature of these is still a matter for debate. https://emj.bmj.com/content/emermed/32/5/e5.1.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-2015-204880.13
    • Student paramedic decision-making: a critical exploration of a patient interaction

      Costello, Barry; Downs, Simon (2021-02)
      Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction. Abstract published with permission.
    • A Study to Assess the Use of Pre-Hospital Charcoal in South East England

      Dines, A. M.; Butler, C.; Taylor, I.; Ovaska, H.; Rowland, A.; Wood, D. M.; Dargan, Prinkeet (2009-06-03)
    • A survey of ambulance clinicians’ perceptions of recording and communicating patient information electronically

      Barrett, Jack; Eaton-Williams, Peter; Mortimer, Craig; Land, Victoria; Williams, Julia (2021-06-01)
      Objective: Ambulance services are evolving from use of paper-based recording of patient information to electronic platforms and the impact of this change has yet to be fully explored. The aim of this study is to explore how the introduction of a system permitting electronic information capture and its subsequent sharing were perceived by the ambulance clinicians using it. Methods: An online questionnaire was designed based upon the technology acceptance model and distributed throughout one ambulance service in the south east of England. Closed-ended questions with Likert scales were used to collect data from patient-facing staff who use an online community falls and diabetic referral platform or an electronic messaging system to update GPs following a patient encounter. Results: There were 273 responses from ambulance clinicians. Most participants agreed that they used tablet computers and smartphones to make their life easier (85% and 86%, respectively). Most participants felt that referring patients to a community falls or diabetic team electronically was an efficient use of their time (81% and 81%, respectively) and many believed that these systems improved the communication of confidential patient information. GP summaries were perceived as increasing time spent on scene but most participants (89%) believed they enabled collaborative working. Overall, collecting and sharing patient information electronically was perceived by most participants as beneficial to their practice. Conclusion: In this study, the ability to electronically refer patients to community services and share patient encounters with the GP was predominantly perceived as both safe for patients and an effective use of the participants’ clinical time. However, there is often still a need to communicate to GPs in real time, demonstrating that technology could complement, rather than replace, how clinicians communicate. Abstract published with permission.
    • Temporal and geographic patterns of stab injuries in young people: a retrospective cohort study from a UK major trauma centre

      Vulliamy, Paul; Faulkner, Mark; Kirkwood, Graham; West, Anita; O'Neill, Breda; Griffiths, Martin P.; Moore, Fionna; Brohi, Karim (2018-11)
      https://bmjopen.bmj.com/content/8/10/e023114.long Objectives To describe the epidemiology of assaults resulting in stab injuries among young people. We hypothesised that there are specific patterns and risk factors for injury in different age groups. Design Eleven-year retrospective cohort study. Setting Urban major trauma centre in the UK. Participants 1824 patients under the age of 25 years presenting to hospital after a stab injury resulting from assault. Outcomes Incident timings and locations were obtained from ambulance service records and triangulated with prospectively collected demographic and injury characteristics recorded in our hospital trauma registry. We used geospatial mapping of individual incidents to investigate the relationships between demographic characteristics and incident timing and location. Results The majority of stabbings occurred in males from deprived communities, with a sharp increase in incidence between the ages of 14 and 18 years. With increasing age, injuries occurred progressively later in the day (r2 =0.66, p<0.01) and were less frequent within 5 km of home (r2 =0.59, p<0.01). Among children (age <16), a significant peak in injuries occurred between 16:00 and 18:00 hours, accounting for 22% (38/172) of injuries in this group compared with 11% (182/1652) of injuries in young adults. In children, stabbings occurred earlier on school days (hours from 08:00: 11.1 vs non-school day 13.7, p<0.01) and a greater proportion were within 5 km of home (90% vs non-school day 74%, p=0.02). Mapping individual incidents demonstrated that the spike in frequency in the late afternoon and early evening was attributable to incidents occurring on school days and close to home. Conclusions Age, gender and deprivation status are potent influences on the risk of violent injury in young people. Stab injuries occur in characteristic temporal and geographical patterns according to age group, with the immediate after-school period associated with a spike in incident frequency in children. This represents an opportunity for targeted prevention strategies in this population. https://bmjopen.bmj.com/content/bmjopen/8/10/e023114.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/bmjopen-2018-023114
    • Tension pneumothorax: are prehospital guidelines safe and what are the alternatives?

      Simons, Phil (2011-02)
      Abstract published with permission. Tension pneumothorax is a life-threatening complication of chest injury. It can cause rapid physiological decompensation, cardiac arrest and death. The Joint Royal Colleges Ambulance Liason Committee (JRCALC) provide guidelines on the prehospital diagnosis and treatment of this condition. The aim of this article is to ask whether or not these guidelines are effective and if there are feasible alternatives to the management of tension pneumothoraces in the prehospital environment.
    • Therapeutic hypothermia in cardiac arrest

      Hart, Lindsay; Newton, Paul (2017-03)
      Abstract published with permission. Therapeutic hypothermia (TH) following cardiac arrest is commonplace in many hospitals. It is thought to improve survival rates and offer neuroprotective benefits. However, its use in the pre-hospital arena is still uncertain. The objective of this literature review is to collect and consider evidence and address these uncertainties with a view to offering recommendations for practice. A systematic search was undertaken, and from the literature reviewed, there was no unanimous evidence that pre-hospital TH improves patient survival or neurological outcomes. It is clear that all of the different modes of initiating TH that were evaluated were effective in reducing patient temperature on arrival at hospital.
    • Todd's paresis in acute mild head trauma

      Cowley, Alan; Wright, David; Breen, Thomas; Lyon, Richard M. (2016-11)
    • UK ambulance services: collaborating to provide good end-of-life care

      Stead, Sarah; Datta, Shirmilla; Hill, James; Smith, Richard; Nicell, Claire (2018-05)
    • Understanding the process and treatment of meningitis and meningococcal disease

      Hodkinson, Mark (2013-05)
      Abstract published with permission. Meningococcal septicaemia is a potentially life-threatening disease process which requires early recognition and rapid management in both pre-hospital and hospital phases of patient care. It is estimated that there are around 3 500 confirmed cases annually in the United Kingdom and, as such, widespread campaigns and national guidelines have been developed and adopted throughout NHS trusts. Standard treatment protocols have been developed and adopted to manage patients appropriately; however, other emerging treatment options are becoming more widely acknowledged, but require further investigation before recommendations can be made. It is vitally important that clinicians in patient-facing roles who are likely to come into contact with meningococcal-related diseases adopt a high index of suspicion, basing diagnosis on history, physical examination and clinical investigations. Rapid intervention should be undertaken for any patient where the disease process is suspected.
    • 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)
    • The use and impact of 12-lead electrocardiograms in acute stroke patients: a systematic review

      Munro, Scott F.S.; Cooke, Debbie; Kiln-Barfoot, Valerie; Quinn, Tom (2018-04)