• Protocol C: a nonguidelines - compliant approach to improve survival of patients with out-of-hospital cardiac arrest

      Chamberlain, Douglas; Fletcher, David; Woollard, Malcolm; Handley, Anthony (2012-06)
    • 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.
    • 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.
    • 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.
    • Paramedic practitioners

      Walter, Alex (2014-02)
    • 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.
    • A qualitative study of 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. (2014-12)
    • A qualitative study of systemic influences on paramedic decision making : care transitions and patient safety

      Shaw, Deborah; Mortimer, Peter; Newman, Chris; Storey, Matthew; Shewan, Jane; O'Hara, Rachel; Johnson, Maxine; Siriwardena, Aloysius; Weyman, Andrew; Turner, Janette; et al. (2015-01)
    • 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.
    • 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.
    • 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
    • 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
    • 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
    • The view from the Ebola Treatment Centre, Makeni, central Sierra Leone.

      Barnes, Solomon; Hussain, Nageena; Hogan, Julia; Logan, Victoria; Wardrope, Jim (2015-07)