• Blurring boundaries

      Gregory, Pete; Mursell, Ian (2006-12)
    • Acute stroke life support: a United States based training course; is it appropriate for and transferable to the English health care setting?

      Davis, David; Crook, D.; Hargroves, D.; Miller, G.; South, A.; Jenkinson, D.; Smithard, D. (2009-12-01)
    • ECPs: avoiding emergency department attendance or hospital admission?

      Coates, David (2010-04)
      The aim of the literature review was to identify and appraise studies that have compared the effectiveness and decision-making of emergency care practitioners with other health professionals. There is no ‘gold standard’ for determining whether the actions of an emergency care practitioner (ECP) results in a patient avoiding attendance at an emergency department (ED) or hospital admission. Consequently, reporting on the cost effectiveness of ECPs is potentially spurious, especially as the cost difference between ED attendance and hospital admission is considerable. Medline and EMBASE databases were searched for publications relevant to the study area. Additional searches were carried out using the online search function offered by the Cochrane Library and the Emergency Medicine Journal. Twenty-nine publications met the inclusion criteria. Nineteen of these papers were considered suitable for background information only. Ten studies were analyzed in further detail and three main themes identified: non-conveyance rates, decision-making and admission avoidance. Studies show that patients assessed by ECPs are less likely to be conveyed to the ED, than when attended by a traditional ambulance response. The Department of Health (DH, 2005) refer to a traditional ambulance service response to a 999 call as sending a double-crewed paramedic ambulance to the patient, provide any necessary life support to stabilize the patient and transport to the ED. The decision-making of ECPs compares favourably with other health professionals when deciding whether a patient can be treated at home, or requires ED attendance or hospital admission. No studies were found that determined whether an ECP is able to accurately decide whether their intervention results in patients avoiding ED attendance or admission. There is a need to evaluate the validity of data collection methods which differentiate between emergency department and admission avoidance as a result of the actions of ECPs. Abstract published with permission.
    • Development and pilot of clinical performance indicators for English ambulance services

      Siriwardena, Aloysius; Shaw, Deborah; Donohoe, Rachel; Black, Sarah; Stephenson, John; National Ambulance Clinical Audit Steering Group (2010-04-12)
      Introduction There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008–2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidence-based interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services. https://emj.bmj.com/content/27/4/327. 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/emj.2009.072397
    • ‘Clearing’ the cervical spine in the unconscious trauma patient

      Blackham, Julian; Benger, Jonathan (2011-01-01)
    • Prehospital intubation in cardiac arrest: The debate continues

      Thomas, Matthew J.C.; Benger, Jonathan (2011-04-01)
    • Glucagon treatment for symptomatic beta blocker overdose

      Fell, Matthew (2011-10-07)
      Symptomatic beta blocker overdose is a relatively uncommon, but potentially life-threatening condition (Sheppard, 2006; Health Protection Agency, 2010). Current definitive treatment for these patients involves intravenous glucagon therapy, and as such, glucagon is considered both a first-line treatment and an antidote in cases of symptomatic beta blocker overdose (Joint Formulary Committee, 2011; National Poisons Information Service, 2011a; 2011b). This case report examines an intentional overdose of propranolol, including paramedic prehospital management, and subsequent in-hospital definitive treatment involving intravenous glucagon therapy. Paramedics have experience and knowledge of administering intramuscular glucagon as part of their formulary, and possess the necessary skills for obtaining intravenous access. Therefore, could intravenous glucagon be considered appropriate for administration by paramedics as a prehospital intervention in cases of symptomatic beta blocker overdose? Abstract published wiht permission.
    • They think it's all over - managing post cardiac arrest syndrome

      Page, Michael (2012-04-06)
      Abstract published with permission. Return of spontaneous circulation (ROSC) is the first stage in the successful management of the cardiac arrest patient. The care that the patient receives during the immediate post-ROSC period, has a major impact on subsequent survival from out of hospital cardiac arrest (OHCA), particularly in terms of surviving to hospital discharge neurologically intact. For the first time, the 2010 Resuscitation Council (UK) (Nolan, 2010) guidelines incorporates a section specifically relating to the mangement of OHCA. This review will outline the guidance from the Resuscitation Council (UK) and the International Liaison Committee On Resuscitation (ILCOR) on the management of post cardiac arrest syndrome (PCAS) and how this can be practically implemented in the pre-hospital environment. interventions directly applicable to the pre-hospital phase until handover at the emergency department (ED) will be considered. In addition, specific guidance relating to the management of the ROSC patient in the pre-hospital phase of their care will be provided.
    • CURE (Community Urgent Response Environment): portable work stations

      Hignett, Sue; Fray, Mike; Benger, Jonathan; Jones, Andrew; Coates, David; Rumsey, John; Mansfield, Neil (2012-06-01)
      The Community Urgent Response Environment (CURE) concept is a new technology system developed to support the work of Emergency Care Practitioners with portable pods and packs and mobile treatment units. This paper describes a project to transfer research outputs from an academic setting into practice through collaboration between two universities, two manufacturers and the United Kingdom (UK) National Health Service. An iterative prototyping process was used with 12 Emergency Care Practitioners evaluating prototypes in two user trials by carrying out four clinical scenarios in three simulated environments (confined domestic, less confined public space, and vehicle). Data were collected with video recording, field notes and post-trial debriefing interviews and analysed thematically. The final prototypes (pod/pack 1.3 and vehicle 1.6) have potential to support a new way of working in the provision of non-critical, pre-hospital care. The user trials also identified possible efficiencies through the use of CURE by providing support for a wider range of assessment, diagnosis and treatment. Abstract published with permission.
    • Reflex anoxic seizure: an important diagnosis to remember

      Prosad Paul, Siba; Zengeya, Stanley; Blaikley, Sarah; Powell, Leanne (2012-07)
      Children may present with a sudden collapsing episode, and the paramedic team is often requested to attend such emergencies. It is important that these episodes are correctly categorised as being either epileptic or non-epileptic events. A reflex anoxic seizure (RAS) is one such presentation. RAS is a paroxysmal, spontaneously-reversing, brief episode of asystole triggered by pain, fear or anxiety. RAS occur due to a brief stoppage of the heart caused by overactivity of the vagus nerve. This is usually triggered by an unpleasant stimulus, following which the child may appear pale and lifeless. The diagnosis is usually made by a paediatrician but it is important that the paramedic team are aware of this condition. A child with a diagnosis of RAS may be managed by reassurance from paramedic practitioners if the child is judged to be well after an episode. https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2012.4.7.409 Abstract published with permission.
    • Can emergency care practitioners differentiate between an avoided emergency department attendance and an avoided admission?

      Coates, David; Rawstorne, Steven; Benger, Jonathan (2012-10)
      After a 999 call to the ambulance service, there is no ‘gold standard’ for determining whether the actions of an emergency care practitioner (ECP) result in a patient avoiding attendance at an emergency department (ED) or avoiding an admission to hospital. Within the Great Western Ambulance Service NHS Trust this outcome has previously been measured using an audit form completed by the ECP. However, the accuracy of the ECP's opinion has not been assessed. https://emj.bmj.com/content/29/10/838.long 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-2011-200484
    • Acute exacerbation of COPD: Are we still over-oxygenating?

      Douglas, Anita (2012-11)
      Chronic obstructive pulmonary disease (COPD) affects thousands of people across the UK. It accounts for a large amount of hospital admissions, which are often seen by the ambulance service during acute exacerbations. Discussion has surrounded the amount of oxygen this type of patient should be receiving during acute exacerbations. Research to provide evidence–based practice for the use of oxygen in the hospital and pre-hospital environment has been ongoing for several years. In 2009 the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) changed their guidance following the British Thoracic Society's (BTS) release of new guidelines in oxygen use in adult patients, thus determining that oxygen should be delivered in a more precise manner. However in light of current evidence could further changes be made in the delivery of oxygen, by using air–driven nebulisation during the delivery of drugs to patients presenting in the pre-hospital environment with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This would allow patients to receive an appropriate amount of oxygen during their transfer to hospital, giving improved care and treatment of patients at risk of hypercapnic respiratory failure. This article will discuss the changes to practice which have already been identified and recommended and also discuss the potential implications these changes may have on patient care. Abstract published with permission.
    • Recognising and managing severe sepsis in the pre-hospital environment

      Small, Mark (2012-11)
      Severe sepsis is a complex medical condition in which the immune system overreacts to an infection leading to circulatory shock and organ failure. Patients with severe sepsis are critically ill and have a high mortality rate in the absence of early aggressive treatment, however, recognition and treatment of the condition remains poor. Recent improvements in the care of patients with myocardial infarction, stroke and multiple trauma have demonstrated how pre-hospital recognition and treatment can greatly improve outcomes for patients, and paramedics are well placed to provide similar improvements to the care of patients with severe sepsis. This article will explore the pathophysiology of sepsis, the recommended treatment bundles suggested by the ‘sepsis six campaign’ and the difficulties faced in implementing such treatments. Finally, it will explore the interventions that could be undertaken by Paramedics to improve patient care. Abstract published with permission.
    • The nature of health and social care partnerships

      Brady, Dr Mike (2013-02)
      Partnership, often wrongly used interchangeably with ‘collaboration’ and ‘inter-agency working’, features regularly in government publications, and is often high on health and social care managers’ agendas. With an increasing emphasis on partnership in politics, society and health care, managers need to understand the concept in relation to their practice, its challenges and the most effective ways of implementing it. This article discusses the multifaceted nature of partnership, explores the benefits and obstacles to achieving successful partnerships and looks at how these can be overcome. https://search.proquest.com/docview/1285578813/fulltextPDF/5CABBFDAAF16415CPQ/1?accountid=48092 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/10.7748/nm2013.01.19.9.30.s9516
    • How to improve patient care by learning from mistakes

      Brady, Dr Mike (2013-02)
      Mistakes made in healthcare settings and the challenges to staff that arise from them can harm service users, consume time and money, and often receive bad publicity. However, by learning from these mistakes and meeting these challenges, practitioners can improve the quality of the care they provide. This article explores what is meant by mistakes and challenges in the context of health care. It suggests that front line managers are best placed to prevent and learn from mistakes, and thereby improve care for patients. https://search.proquest.com/docview/1314303097/fulltextPDF/1B3083DD1AA04444PQ/1?accountid=48092 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/10.7748/en2013.02.20.9.32.e679
    • Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of prehospital cardiac arrest (REVIVE-Airways): a feasibility study research protocol

      Benger, Jonathan; Voss, Sarah; Coates, David; Greenwood, Rosemary; Nolan, Jerry; Rawstorne, Steven; Rhys, Megan; Thomas, Matthew (2013-02-13)
      Effective cardiopulmonary resuscitation with appropriate airway management improves outcomes following out-of-hospital cardiac arrest (OHCA). Historically, tracheal intubation has been accepted as the optimal form of OHCA airway management in the UK. The Joint Royal Colleges Ambulance Liaison Committee recently concluded that newer supraglottic airway devices (SADs) are safe and effective devices for hospital procedures and that their use in OHCA should be investigated. This study will address an identified gap in current knowledge by assessing whether it is feasible to use a cluster randomised design to compare SADs with current practice, and also to each other, during OHCA. https://bmjopen.bmj.com/content/3/2/e002467 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/bmjopen-2012-002467
    • Reducing thrombolysis call to needle times - preliminary results from the Stroke90 project

      Kendall, J.M.; Dutta, D.; Brown, E.A.M.; Caine, S.E.; Whiting, R.; Bosnell, R.; Shaw, L.J.; Black, T.; Rashed, K.A.; Aujla, K.S.; et al. (2013-05)