• 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)
    • The use of prehospital 12-lead electrocardiograms in acute stroke patients

      Cooke, Debbie; Joy, Mark; Quinn, Tom (2018-04)
      AIM Emergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke , but this recommendation is based on expert consensus, rather than robust evidence. The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received. Method A multicentre retrospective cohort study was undertaken. The data collection period spanned from 29/12/2013 – 30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number. Results PHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.44, 95% CI: 1.14 to 1.82, p=0.002) and in-hospital mortality (aOR 2.07, 95% CI: 1.42 to 3.00, p=0.0001). There was no association between PHECG and administration of thrombolysis (aOR 0.92, 95% CI: 0.65 to 1.30, p=0.63). Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.14) or thrombolysis (median 46 min vs 48 min, p=0.82) were observed. Conclusion This is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in Abstracts BMJ Open 2018;8(Suppl 1):A1–A34 A5 Trust (NHS). Protected by copyright. on September 3, 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.14 on 16 April 2018. Downloaded from regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke. https://bmjopen.bmj.com/content/bmjopen/8/Suppl_1/A5.3.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/bmjopen-2018-EMS.14
    • Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals

      Fletcher, David; Chamberlain, Douglas; Handley, Anthony; Woollard, Malcolm; Pateman, Jane; Nela, Svetlana; Bryant, Geoffrey (2011-10)
    • Vehicles and equipment for land-based neonatal transport

      Kempley, S. T.; Ratnavel, Nandiran; Fellows, T. (2009-08)
    • Videoscopes: an additional tool for managing the pre-hospital airway

      Hodkinson, Mark (2013-09)
      Abstract published with permission. Airway management by pre-hospital care providers is often the subject of intense debate. It is recognised that there are wide variations in clinical training and skill fade is high among paramedics due to lack of experience and exposure (Hodkinson, 2010). Recent years have seen the development of a wide variety of video based laryngoscope devices, several of which have potential application to the pre-hospital field. There are a number of advantages and disadvantages to these devices, which are explored in more detail. Prior to any recommendations being made, further research including clinical trials would be required in the pre-hospital field, to assess the suitability of videoscope devices for paramedic airway management.
    • The view from the Ebola Treatment Centre, Makeni, central Sierra Leone.

      Barnes, Solomon; Hussain, Nageena; Hogan, Julia; Logan, Victoria; Wardrope, Jim (2015-07)
    • 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.
    • What is the most appropriate out-of-hospital opioid for adults with traumatic pain?

      Ellis, Pierre (2017-12-06)
      Methods: The literature search was carried out using multiple databases to identify relevant out-of-hospital research with additional grey literature to support. The main themes encountered were intravenous morphine compared to intravenous fentanyl, and the contrast between them. Discussion: There were no significant differences in effectiveness or adverse effects. Intranasal application was thought to be favoured where intravenous access was unobtainable. Conclusions: Further research is required to establish which is the most appropriate opioid. This could include a greater focus on the onset time, duration and optimal dose. Increased education and organisational focus would need to be addressed alongside a change in drug formulary for the out-of-hospital clinician. Abstract published with permission.