RSS 1.0Publications - South Western Ambulance Service
Recent Submissions
-
Temperature management of babies born in the prehospital setting: an analysis of call-handler advice and staff and patient viewsBackground Following prehospital birth, babies can become hypothermic within minutes, sometimes before paramedics arrive. The risk of the baby dying increases by at least 28% for every degree that their temperature drops below <36.5°C. The earlier we can provide effective warming interventions, the lower the risk of poor outcomes. The aim of this project was to 1), examine the neonatal temperature management advice given to people calling 999 about a prehospital birth in the UK and 2), explore NHS staff and patient views about the content and accessibility of advice given. Methods All 999 calls between January 2021-January 2022 were searched by the Clinical Information and Records teams at two ambulance services using the two different triage systems (AMPDS and NHS Pathways). Thirty eligible calls were selected from postcodes with varying levels of deprivation and passed to the study team for content analysis. Nine focus groups were held with 18 NHS staff (paramedics, midwives, neonatal nurses/doctors, call-handlers), and 22 members of the public who had experienced prehospital birth, to discuss the content and accessibility of the advice given. Results Five themes were identified as potential barriers to good quality neonatal temperature management: confusing or conflicting advice on where the baby should be placed following birth, vague or unclear instructions on warming the baby, the timing of temperature management advice, the priority given to other instructions, and a lack of importance placed on neonatal temperature. Participants suggested a number of simple changes to advice, including increased focus on the importance of neonatal temperature, encouraging skin-to-skin contact, and providing specific advice on warming the baby. Conclusions There is an opportunity to improve the neonatal temperature management advice given by 999 call-handlers during calls related to prehospital birth. This could reduce the number of babies arriving at hospital hypothermic, therefore improving outcomes. https://doi.org/10.1136/emermed-2023-999.7 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/
-
Perceptions of establishing advanced life support for out-of-hospital cardiac arrestEstablishing advanced life support (ALS) in out-of-hospital cardiac arrest (OHCA) is a demanding part of the paramedic role. While aspects of these patients’ care have been well researched, examination of how the full ALS bundle is completed is lacking. This study aims to explore paramedics’ experience of establishing ALS in OHCA through individual semi-structured interviews to identify potential themes and transferable learning. Findings in the areas of dispatch, en-route planning and on-scene care as well as around training were identified through thematic analysis. There are several issues on which individuals and organisations can critically reflect to improve practice. Abstract published with permission.
-
Implementation of electronic patient clinical records in ambulances in the UK: a national surveyBackground The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances. Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage. Methods We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction. The interviews were transcribed and thematically analysed, by three members of the research team. Results We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care. Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments. Implications Implementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others. https://emj.bmj.com/content/36/1/e7.3 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/ DOI http://dx.doi.org/10.1136/openhrt-2015-000281
-
The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort studyBackground Use of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Objectives To investigate differences in mortality between those who did/did not receive PHECG. Methods Population-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017. Results Of 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30- day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001). Conclusion PHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients https://emj.bmj.com/content/38/9/A2.1 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/ DOI http://dx.doi.org/10.1136/openhrt-2015-000281
-
Transforming stroke care : pivotal role of the ambulance servicesStroke is the brain equivalent of a heart attack. With 1.9 million neurons being lost every minute, early access to acute care is critical. Ambulance clinicians have a vital role in ensuring the rapid assessment and transfer of patients to an acute stroke centre, as the principle barrier to delivering thrombolysis is enabling treatment within the narrow therapeutic time window. Timely management of transient ischaemic attacks (TIAs) reduces mortality, morbidity and use of precious NHS resources. Ambulance services need to develop pathways that embrace the vision of the National Stroke Strategy, risk stratifying patients and facilitating immediate hospital admission or referral to timely clinics. Abstract published with permission
-
Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedicsBackground Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics. Methods A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA. Results There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5degreeC. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement. Conclusions This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement. 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/
-
Perceptions and experiences of mental health support for ambulance employeesBackground: Mental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, employees experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. Aims: To investigate ambulance staff perceptions and experiences of organisational mental health support. Methods: A cross-sectional online survey investigated work-related stressful life events and their potential psychological impact. The survey also examined staff perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time to talk at work. Findings: A total of 540 ambulance staff responded. The majority reported having experienced work-related stressful life events (n=444; 82%). Associated psychological symptoms appeared to persist for years. Perceptions about organisational support related to support uptake. Stigma, fear and embarrassment were reported as barriers to disclosure and help-seeking. Mandatory time to talk at work would be acceptable (n=400; 74%). Conclusion: The association between work-related stressful events and psychological symptoms underscores the need for interventions supported at an organisation level. Abstract published with permission.
-
The impact of COVID-19 on emergency medical service-led out-of-hospital cardiac arrest resuscitation: a qualitative studyBackground: Following the emergence of COVID-19, there have been local and national changes in the way emergency medical service (EMS) staff respond to and treat patients in out-of-hospital cardiac arrest (OHCA). The views of EMS staff on the impact of COVID-19 and management of OHCA have not previously been explored. This study aimed to explore the views of staff, with a specific focus on communication during resuscitation, resuscitation procedures and the perception of risk. Methods: A qualitative phenomenological enquiry was conducted. A purposive sample of n = 20 participants of various clinical grades was selected from NHS EMS providers in the United Kingdom. Data were collected using semi-structured interviews, transcribed verbatim and inductive thematic analysis was applied. Results: Three main themes emerged which varied according to clinical grade, location and guidelines.Decision making: Staff generally felt supported to make best-interest termination of resuscitation decisions. Staff made informed decisions to compromise on recommended levels of personal protective equipment (PPE), since it felt impractical in the pre-hospital context, to improve communication or to reduce delays to care.Service pressures: Availability of operational staff and in-hospital capacity were reduced. Staff felt pressure and disconnect from the continuous updates to clinical guidelines which resulted in organisational change fatigue.Moral injury: The emotional impacts of prolonged and frequent exposure to failed resuscitation attempts and patient death caused many staff to take time away from work to recover. Conclusion: This qualitative study is the first known to explore staff views on the impacts of COVID-19 on OHCA resuscitation, which found positive outcomes but also negative impacts important to inform EMS systems. Staff felt that COVID-19 created delays to the delivery of resuscitation, which were multi-faceted. Staff developed new ways of working to overcome the barriers of impractical PPE. There was little impact on resuscitation procedures. Moving forwards, EMS should consider how to limit organisational change and better support the ongoing emotional impacts on staff. Abstract published with permission.
-
Virtual reality: the future or a COVID-era plaster?The COVID-19 pandemic has placed the UK NHS under considerable stress (NHS Providers and Association of Ambulance Chief Executives (AACE), 2021). One consequence of delivering the frontline response was the reduced capacity of UK emergency medical service (EMS) ambulance organisations to provide practical placement opportunities for undergraduate paramedic students (Council of Deans of Health, 2020). Physical distancing requirements (Sørensen et al, 2021) prevented many students from undertaking ‘on-the-road’ ambulance shifts, compromising their learning experience. To ensure that paramedic students received the training required to meet course objectives, a large NHS EMS organisation in South West England secured funding from Health Education England (HEE) to explore whether virtual reality (VR) technology could bridge the gap. Abstract published with permission.
-
Swindon Heart Attack Program to Evaluate and Improve Timing of Angiography in nstemi (shape-it nstemi)To improve NSTEMI care; with a particular focus on the timing of angiography in NSTEMI and same day discharge after angiography and follow on percutaneous coronary inter vention (PCI).Setting: Single site non-surgical centre in the NHS, with a national target for 75% of NSTEMI patients to have angiography within 72 hours of admission. https://heart.bmj.com/content/heartjnl/108/Suppl_1/A33.1.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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/heartjnl-2022-BCS.44
