Recent Submissions

  • Experiences and views of people who frequently call emergency ambulance services: a qualitative study of UK service users

    Evans, Bridie; Khanom, Ashra; Edwards, Bethan; Foster, Theresa; Fothergill, Rachael; Gripper, Penny; Porter, Alison; Scott, Jason; Watkins, Alan; Edwards, Adrian; et al. (2023-08-09)
  • A response to 'Fighting the fire': fire chiefs' proposal to run England's ambulance service...‘Fighting the fire: a response to fire chiefs’, October, 2010

    Jones, Peter; Woollard, Malcolm (MAG Online, 2011-02-04)
    In October 2010, JPP published a comment by Prof Malcolm Woollard, titled ‘Fighting the fire: a response to fire chiefs’ proposal to run England’s ambulance service’, expressing his view as to why the proposal by the Chief Fire Officers Association (CFOA) is not workable. JPP has received a letter regarding this, which is printed below, along with a response from Prof Woollard that also discusses the latest report published by the CFOA. Abstract published with permission
  • Case management of people who call 999 frequently – qualitative study of the perspective of people providing and receiving care (STRETCHED)

    Snooks, Helen; Khanom, Ashra; Cole, Robert; Edwards, Adrian; Evans, Bridie; Foster, Theresa; Gripper, Penny; Hampton, Chelsey; John, Ann; Petterson, Robin; et al.
  • Drug routes in out-of-hospital cardiac arrest: a summary of current evidence

    Hooper, Amy; Nolan, Jerry; Rees, Nigel; Walker, Alison; Perkins, Gavin; Couper, Keith (Elsevier, 2022-12)
  • Surviving an out-of-hospital hypothermic cardiac arrest in the United Kingdom

    Evans, Stuart (The College of Paramedics, 2023-03-01)
    Introduction: Hypothermia is an uncommon cause of cardiac arrest in the United Kingdom, and more commonly occurs in countries experiencing avalanches and significant winter climates; however, this case demonstrates that the presentation can occur in the United Kingdom. This case adds to a body of evidence that prolonged resuscitation can be successful in patients suffering a cardiac arrest secondary to hypothermia, leading to a good neurological outcome. Case presentation: The patient suffered a witnessed out-of-hospital cardiac arrest following rescue from a free-flowing river, and underwent prolonged resuscitation. The patient presented in persistent ventricular fibrillation, unresponsive to defibrillation attempts. An oesophageal probe recorded the patient’s temperature as 24°C. Rescuers were guided by the Resuscitation Council UK advanced life support algorithm to withhold drug therapy and limit defibrillation attempts to three, until the patient had been rewarmed to above 30°C. Appropriate triage of the patient to an extracorporeal life support (ECLS) capable centre allowed specialised treatment to be initiated, and culminated in successful resuscitation once normothermia was restored. After a short stay in intensive care, the patient was discharged for rehabilitation due to a hypoxic spinal cord injury before discharge home. Conclusion: This case highlights that hypothermia is a reversible cause of cardiac arrest, which needs to be recognised and acted upon appropriately to provide the best possible chance for a positive outcome. Low-reading thermometers capable of identifying the temperature thresholds stated in the Resuscitation Council UK guidelines are required, to allow clinicians to adapt their practice according to the presenting situation. Tympanic thermometers are often limited to their lowest recordable temperature, and invasive monitoring such as oesophageal or rectal probes are not common in UK ambulance service practice. With the necessary equipment, patients can be triaged to an ECLS-capable centre, allowing them to receive the specialist rewarming that they require. Abstract published with permission.
  • 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 study

    Quinn, Tom; Driscoll, Timothy; Gavalova, Lucia; Halter, Mary; Gale, Chris P; Weston, Clive FM; Watkins, Alan; Munro, Scott; Davies, Glen; Rosser, Andy; et al.
    Background 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
  • Taking services to the streets over the party season

    Brace, Samantha; Farmer, Christopher; Calow, Phil (2009-12-20)
  • Recognition of life extinct and the processes of death

    Shrehorn, Thomas (2009-09-30)
    A paramedic has the responsibility to confirm deaths within the community in which they work and there are distinct protocols to follow. They also have the responsibility to decide whether or not to carry out cardiopulmonary resuscitation on expected and unexpected deaths. The recognition of life extinct (ROLE) protocol included in the Joint Colleges Ambulance Liaison Committee Guidelines (2006) provides guidance on when, and when not, to perform cardiopulmonary resuscitation on patients but does not cover the processes occurring after death. Death is a process which occurs in stages and within certain time constraints, depending on intrinsic and extrinsic factors. This article covers the processes of death and the timelines in which they occur and aims to improve the paramedic's knowledge and ability to make sound judgements and assist with providing justifications of confirming death alongside the ROLE protocol to relatives, the police and the coroner. Abstract published with permission
  • Diagnostic accuracy of clinical pathways for suspected acute myocardial infarction in the out-of-hospital environment

    Alghamdi, Abdulrhman; Hann, Mark; Carlton, Edward; Cooper, Jamie G.; Cook, Eloïse; Foulkes, Angela; Siriwardena, Aloysius; Phillips, John; Thompson, Alexander; Bell, Steve; et al. (2023-06-10)
  • Which patients should be pre-alerted? A review of UK ambulance service guidelines

    Boyd, Aimee; Sampson, Fiona; Pilbury, Richard; Bell, Fiona; Millins, Mark; Coster, Joanne; Rosser, Andy; Spaight, Robert
  • Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: The Utstein style

    Castren, M; Karlsten, R; Lippert, F; Christensen, E. F; Bovim, E; Kvam, A. M; Robertson-Steel, I; Overton, J; Kraft, T; Engerstrom, L; et al. (2008-11)
  • 'Every day was a learning curve': Implementing Covid-19 triage protocols

    Porter, A; Bell, F; Brady, M; Brown, S; Carson-Stevens, A; Duncan, E; England, L; Evans, B; Foster, T; Gallanders, J; et al.
    Background TRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic's first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols. Method Research paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants' accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together. Results We identified the following themes: Constantly changing guidelines - at some points, updated several times a day. The ambulance service as part of the wider healthcare system - changes elsewhere in the system left ambulance services as the default. Peaks and troughs of demand - fluctuating greatly over time, and varying across the staff groups. A stretched system - resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED. Emotional load of responding to the pandemic - including call centre staff. Doing the best they can in the face of uncertainty - a rapidly evolving situation unlike any which ambulance services had faced before. Conclusion Implementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load. https://bmjopen.bmj.com/content/12/Suppl_1/A16.1 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
  • Location of out-of-hospital cardiac arrests and automated external defibrillators in relation to schools in an English ambulance service region

    Benson, Madeleine; Brown, Terry P.; Booth, Scott; Achana, Felix; Smith, Christopher; Price, Gill; Ward, Matthew; Hawkes, Claire A.; Perkins, Gavin (2022-07-26)
  • The Utility of Ambulance Dispatch Call Syndromic Surveillance for Detecting and Assessing the Health Impact of Extreme Weather Events in England

    Packer, Simon; Loveridge, Paul; Soriano, Ana; Morbey, Roger A.; Todkill, Dan; Thompson, Ross; Rayment-Bishop, Tracy; James, Cathryn; Pillin, Hilary; Smith, Gillian; et al. (2022-04-01)
  • STRategies to manage Emergency ambulance Telephone Callers with sustained High needs: an Evaluation using linked Data (STRETCHED) - a study protocol

    Aslam, Rabeea’h W.; Snooks, Helen; Porter, Alison; Khanom, Ashrafunnesa; Cole, Robert; Edwards, Adrian; Edwards, Bethan; Evans, Bridie A.; Foster, Theresa; Fothergill, Rachael; et al. (2022-03)
    UK ambulance services have identified a concern with high users of the 999 service and have set up ‘frequent callers’ services, ranging from within-service management to cross-sectoral multidisciplinary case management approaches. There is little evidence about how to address the needs of this patient group. https://bmjopen.bmj.com/content/12/3/e053123.info 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-2021-053123
  • Out-of-hospital cardiac arrest due to hanging: a retrospective analysis

    Turner, Jake; Brown, Aidan; Boldy, Rhiannon; Lumley-Holmes, Jenny; Rosser, Andy; James, Alex (22-02)
    There has been little research into the prehospital management of cardiac arrest following hanging despite it being among the most prevalent methods of suicide worldwide. The aim of this study was to report the characteristics, resuscitative treatment and outcomes of patients managed in the prehospital environment for cardiac arrest secondary to hanging and compare these with all-cause out-of-hospital cardiac arrest (OHCA) https://amber.openrepository.com/handle/20.500.12417/29/submit/21385c672c0e3116014449663456311a416a7910.continue 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-2020-210839
  • Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial

    Crombie, Nicholas; Doughty, Heidi; Bishop, Jonathan R.B.; Desai, Amisha; Dixon, Emily F.; Hancox, James M.; Herbert, Mike J.; Leech, Caroline; Lewis, Simon J; Nash, Mark R; et al. (2022-04)
  • A paramedic's role in reducing number of falls and fall-related emergency service use by over 65s: a systematic review

    Bonner, Mhairi; Capsey, Matt; Batey, Jo (2021-05-01)
    Background: Around 10–25% of emergency calls for adults aged over 65 are attributed to falls. Regardless of whether injuries are caused, quality of life is often affected by fear of falling, leading to reduced confidence and activity, negatively impacting mobility and risking depression and isolation. Ambulance service staff are well placed to identify falls risk factors so patients can be directed to falls prevention services. This article aims to determine how the referral by paramedics of uninjured falls patients to community falls services may reduce future falls and emergency services use. http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=93c754e6-fdac-46d2-9a69-95fb0f3e91e0%40sdc-v-sessmgr03 http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.29045/14784726.2021.6.6.1.46 Abstract published with permission

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