• Ambulance clinicians' perceptions, assessment and management of frailty: thematic analysis of focus groups

      Green, Jonathan; Kirby, Kim; Hope, Suzy (2018-12-01)
      Introduction: More than half of all patients attended by the South Western Ambulance Service NHS Foundation Trust are over the age of 65. In 2017, 62% of older patients who were the subject of a frailty assessment were believed to have at least mild frailty (1/5 of all patients). Frailty is an increasingly relevant concept/diagnosis and ambulance services are well positioned to identify frailty and influence the 'care pathways' through which patients are directed (thereby influencing health outcomes). Throughout the South Western Ambulance Service NHS Foundation Trust, a mandatory training session regarding frailty was delivered to clinical personnel in 2017 and frailty assessment tools are available on the electronic Patient Clinical Record. Aim: To explore and gain insight into the current knowledge, practice and attitudes of ambulance clinicians regarding frailty and patients with frailty. Methods: Two focus groups of ambulance clinicians (n = 8; n = 9) recruited from across the South Western Ambulance Service NHS Foundation Trust were held in October 2017. Focus group discussions were analysed thematically. Results: Knowledge of conceptual models of frailty, appropriate assessment of patients with frailty and appropriate care pathways varied substantially among focus group participants. Completion of the 'Rockwood' Clinical Frailty Scale for relevant patients has become routine. However, conflicting opinions were expressed regarding the context and purpose of this. The Timed-Up-and-Go mobility assessment tool is also on the electronic Patient Clinical Record, but difficulties regarding its completion were expressed.Patient management strategies ranged from treatment options which the ambulance service can provide, to referrals to primary/community care which can support the management of patients in their homes, and options to refer patients directly to hospital units or specialists with the aim of facilitating appropriate assessment, treatment and discharge. Perceptions of limited availability and geographical variability regarding these referral pathways was a major feature of the discussions, raising questions regarding awareness, capacity, inter-professional relationships and patient choice. Conclusion: Knowledge, practice and attitudes of ambulance staff, with regard to frailty, varied widely. This reflected the emerging nature of the condition, both academically and clinically, within the ambulance profession and the wider healthcare system. Abstract published with permission.
    • Blurring boundaries

      Gregory, Pete; Mursell, Ian (2006-12)
    • 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.
    • An exploration of the experiences of paramedics taking part in a large randomised trial of airway management, and the impact on their views and practice

      Kirby, Kim; Brandling, Janet; Robinson, Maria; Voss, Sarah; Benger, Jonathan (2019-09-24)
      Background The participation of over 1500 study paramedics in AIRWAYS-2 provides a unique opportunity for an in depth exploration of how the views and practice of study paramedics, in advanced airway management, may have developed as a result of their participation in AIRWAYS-2, and how their experiences can inform future trials in out-of-hospital cardiac arrest (OHCA). Future prehospital guidelines and practice will not only be shaped by the results of large trials such as AIRWAYS-2, but also by the views and attitudes of UK paramedics towards OHCA, airway management and research. This study allows an opportunity to add depth and understanding to the results of AIRWAYS-2. Study aims To explore paramedics’ experiences of participating in a large cluster randomized trial of airway management during OHCA, specifically: The challenges of enrolling patients who are critically unwell and unable to consent; Barriers and facilitators to successful research in OHCA patients; The impact on paramedics’ clinical practice and airway management during and after the trial; The role of advanced airway management during OHCA. Methods Content analysis of an online survey of 1500 study paramedics to assess their experiences of participating in the trial and to establish any changes in their views and practice. Thematic analysis of telephone interviews with study paramedic to explore the findings of the online questionnaire. Exploring any changes in views and practice around advanced airway management as a result of participating in the trial; assessing experiences of trial training and enrolling critically unwell patients without consent, and exploring the barriers and facilitators for trial participation and the views of paramedics on the future role of advanced airway management during OHCA. Results and conclusions The study is in the analysis phase and is due to complete and report by the 31st January 2019. https://emj.bmj.com/content/36/10/e12.1. 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/emermed-2019-999abs.27
    • The impact of working shifts: exploring the views of UK paramedics

      Kirby, Kim; Moreland, Stephanie; Pollard, John (2016-05-11)
      There is limited research within the UK investigating the effects of shift work on paramedics. Paramedics have relatively high rates of sickness levels and there are links between shift work and health. This study explores UK paramedics’ perceptions of the impact of working shifts. Methods: Exploratory qualitative research was utilised to investigate the perceptions of UK paramedics on the impacts of working shifts. Two focus groups were completed involving 11 paramedics. The transcriptions were analysed using thematic analysis. Results: Paramedics described factors associated with working shifts that mirror research already completed within different occupations: effects on physical health, fatigue, family life, safety and performance; but paramedics additionally described factors that are more limited to working in the paramedic profession such as a broader range of psychological stressors and organisational factors. The theme of psychological health was a wider theme that went beyond shift work and encompassed the overall paramedic role and the unique and stressful nature of the work. Conclusions: This research has allowed an insight into the perceived effects of shift work on UK paramedics and exposes the challenges paramedics face in their working environment. There is a suggested link between the relatively high rates of sickness and the effects of shift work and paramedics’ overall working environment. Further exploration and recognition of the effects of shift work on UK paramedics is recommended. Abstract published with permission.
    • Storytelling via social media in the ambulance services

      Cotton, Mark; MacGregor, Murray; Warner, Claire; Bateson, Fiona (2019-09-11)
    • 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.