• Presence of a pre-hospital enhanced care team reduces on scene time and improves triage compliance for stab trauma

      Cowley, Alan; Durham, Mark; Aldred, Duncan; Crabb, Richard; Crouch, Paul; Heywood, Adam; McBride, Andy; Williams, Julia; Lyon, Richard M. (2019-09-06)
    • The primacy of basics in advanced life support

      Chamberlain, Douglas; Frenneaux, Michael; Fletcher, David (2009-06)
    • Professionalism in paramedic practice: the views of paramedics and paramedic students

      Gallagher, Ann; Vyvyan, Emma; Juniper, Joan; Snook, Verity; Horsfield, Claire; Collen, Andy; Rutland, Stuart (2016-09)
      Abstract published with permission. Paramedic practice is complex and involves decision-making in situations that are often complex and pressured. A high level of professionalism is required to respond appropriately. There has been little previous research in this area. The aim of the Consensus towards Understanding and Sustaining Professionalism in Paramedic Practice project was to develop an in-depth understanding of professionalism in paramedic practice (CUSPPP). This article reports findings from the qualitative component of the CUSPPP project. Interviews were conducted with clinical managers, specialist paramedics and student paramedics. A favourable ethical opinion was obtained from the University of Surrey Ethics Committee. Data were analysed thematically and three themes identified are discussed in this article: components of paramedic professionalism; professionalism enablers; and professionalism inhibitors. Components of paramedic professionalism include: the conduct of paramedics; the role of regulation; professional education; and values for paramedic practice. Paramedic professionalism enablers and inhibitors relate to three levels: individual, organisational and regulatory/societal levels. On-going education and interventions that promote paramedics’ well-being should be discussed with ambulance trusts and collaboration established to promote the development of educational materials and further research.
    • 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)
    • 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)
    • A randomized trial of epinephrine in out-of-hospital cardiac arrest

      Perkins, Gavin D.; Ji, Chen; Deakin, Charles D.; Quinn, Tom; Nolan, Jerry P.; Scomparin, Charlotte; Regan, Scott; Long, John; Slowther, Anne-Marie; Pocock, Helen; et al. (2018-08)
    • A retrospective analysis of ketamine administration by critical care paramedics in a pre-hospital care setting

      Cowley, Alan; Williams, Julia; Westhead, Pete; Gray, Nick; Watts, Adam; Moore, Fionna (2018-03)
      Abstract published with permission. Objective: This project aims to describe pre-hospital use of ketamine in trauma by South East Coast Ambulance Service critical care paramedics and evaluate the occurrence of any side effects or adverse events. Methods: A retrospective analysis of patients receiving pre-hospital ketamine for trauma between 16 March 2013 and 30 April 2017. Administrations were identified from Advanced Life Saving Interventions and Procedures reports submitted by the clinician and, later, from an electronic database. Each was scrutinised for patient demographics, doses and reports of side effects or adverse events. Results: A total of 510 unique administrations were identified. Following the exclusion of 61 records, 449 (88.0%) administrations remained. The most common indication for administration of ketamine was lower limb injury, with 228 (50.8%) administrations. Ketamine was only administered intravenously, and the median dose of ketamine for all administrations was 30 mg (interquartile range 20‐40 mg). The gender split was dominated by males who accounted for 302 (67.3%) administrations compared to 147 (32.7%) females. The median age of patients was 44 years (interquartile range 28‐58 years), with women on average being older than men. Telephone calls to a consultant were made for 243/449 (54.1%) of the administrations, reflecting a need for sanctioning of the drug, advice on dosages or indications, for example. Conclusions: Critical care paramedics within a well governed system are able to safely administer ketamine within an approved dosing regimen under a Patient Group Direction. Median doses are in keeping with nationally approved guidelines. Reported side effects were within the described frequencies in the British National Formulary. Prospective studies are now needed in order to confirm the safety and efficacy of ketamine administration among the advanced paramedic population.
    • A retrospective review of patients with significant traumatic brain injury transported by emergency medical services within the south east of England

      Barrett, Jack (2019-03)
      Traumatic brain injury (TBI) will be a leading cause of death and disability within the Western world by 2020. Currently, 80% of all TBI patients in England are transported to hospital by an ambulance service. The aim of this retrospective study is to compare TBI patients transported to a major trauma centre (MTC) against those transported to a trauma unit (TU). Abstract published with permission.
    • A review of the burden of trauma pain in emergency settings in Europe

      Dissman, Patrick D.; Maignan, Maxime; Cloves, Paul D.; Gutierrez Parres, Blanca; Dickerson, Sara; Eberhardt, Alice (2018-12)
    • Rudolf Juchems — A pioneer of cardiopulmonary resuscitation in Germany

      Böttiger, Bernd W.; Chamberlain, Douglas; Bossaert, Leo; Juchems, Markus (2009-10)
    • 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)