• 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
    • Experts' perspectives on professionalism in paramedic practice: findings from a Delphi process

      Gallagher, Ann; Snook, Verity; Horsfield, Claire; Rutland, Stuart; Vyvyan, Emma; Juniper, Joan; Collen, Andy (2016-09)
      Abstract published with permission. This article reports findings from a Delphi process which aimed to enable an expert panel to reach consensus in the following areas: the meaning of ‘professionalism’ in the context of UK paramedic practice; enablers of professionalism in paramedic practice; interventions or approaches likely to promote or sustain paramedic professionalism; and values that underpin paramedic professionalism. The research project was the Consensus towards Understanding and Sustaining Professionalism in Paramedic Practice (CUSPPP) project. The Delphi panel consisted of 12 experts from education, leadership, management and senior clinical roles, as well as a service user. The data from each of the three rounds were distilled to statements using a basic content analysis and subjected to team review. Statements that achieve 75% (where participants agreed or strongly agreed on a Likert scale) were considered to have reached consensus. The data highlight the view that responsibility for paramedic professionalism goes beyond individuals, with organisations having a key role in providing support and debriefing opportunities and demonstrating the value of human rather than material resources. Further research relating to the topic of paramedic professionalism is necessary, and a crucial component of this is to also capture the views and experiences of service users and the general public.
    • Exploring paramedic perceptions of feedback using a phenomenological approach

      Eaton-Williams, Peter; Mold, Freda; Magnusson, Carin (2020-06-01)
      Abstract published with permission. Objectives: Despite widespread advocacy of a feedback culture in healthcare, paramedics receive little feedback on their clinical performance. Provision of ‘outcome feedback’, or information concerning health-related patient outcomes following incidents that paramedics have attended, is proposed, to provide paramedics with a means of assessing and developing their diagnostic and decision-making skills. To inform the design of feedback mechanisms, this study aimed to explore the perceptions of paramedics concerning current feedback provision and to discover their attitudes towards formal provision of patient outcome feedback. Methods: Convenience sampling from a single ambulance station in the United Kingdom (UK) resulted in eight paramedics participating in semi-structured interviews. Interpretative phenomenological analysis was employed to generate descriptive and interpretative themes related to both current and potential feedback provision. Results: The perception that only exceptional incidents initiate feedback, and that often the required depth of information supplied is lacking, resulted in some participants describing an isolation of their daily practice. Barriers and limitations of the informal processes currently employed to access feedback were also highlighted. Formal provision of outcome feedback was anticipated by participants to benefit the integration and progression of the paramedic profession as a whole, in addition to facilitating the continued development and well-being of the individual clinician. Participants anticipated feedback to be delivered electronically to minimise resource demands, with delivery initiated by the individual clinician. However, a level of support or supervision may also be required to minimise the potential for harmful consequences. Conclusions: Establishing a just feedback culture within paramedic practice may reduce a perceived isolation of clinical practice, enabling both individual development and progression of the profession. Carefully designed formal outcome feedback mechanisms should be initiated and subsequently evaluated to establish resultant benefits and costs.
    • 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.