• The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure

      Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Perkins, Gavin D.; Ward, Matthew; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Bradburn, Mike; Thokala, Praveen; et al. (2018-06)
    • Bystander cardiopulmonary resuscitation: Impact of training initiatives

      Brown, Terry P.; Booth, Scott; Lockey, Andrew S.; Askew, Sara; Hawkes, Claire A.; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Gunson, Imogen; Soar, Jasmeet; et al. (2018-09)
    • Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Soar, Jasmeet; Mark, Julian; Mapstone, James; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Bichmann, Anna; et al. (2019-01-01)
    • Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

      Rajagopal, Sangeerthana; Kaye, Charlotte; Lall, Ranjit; Deakin, Charles D.; Gates, Simon; Pocock, Helen; Quinn, Tom; Rees, Nigel; Smyth, Michael A.; Perkins, Gavin D. (2016-12)
    • Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest

      Achana, Felix; Petrou, Stavros; Madan, Jason; Khan, Kamran; Ji, Chen; Hossain, Anower; Lall, Ranjit; Slowther, Anne Marie; Deakin, Charles; Quinn, Tom; et al. (2020-09-27)
    • Cost-effectiveness of out-of-hospital continuous positive airway pressure for acute respiratory failure

      Thokala, Praveen; Goodacre, Steve; Ward, Matthew; Penn-Ashman, Jerry; Perkins, Gavin D. (2015-05)
    • Data quality and 30-day survival for out-of-hospital cardiac arrest in the UK out-of-hospital cardiac arrest registry: a data linkage study

      Rajagopal, Sangeerthana; Booth, Scott; Brown, Terry P.; Ji, Chen; Hawkes, Claire A.; Siriwardena, Aloysius; Kirby, Kim; Black, Sarah; Spaight, Robert; Gunson, Imogen; et al. (2017-11)
      Objectives The Out-of-Hospital Cardiac Arrest Outcomes (OHCAO) project aims to understand the epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) across the UK. This data linkage study is a subproject of OHCAO. The aim was to establish the feasibility of linking OHCAO data to National Health Service (NHS) patient demographic data and Office for National Statistics (ONS) date of death data held on the NHS Personal Demographics Service (PDS) database to improve OHCAO demographic data quality and enable analysis of 30-day survival from OHCA. Design and setting Data were collected from 1 January 2014 to 31 December 2014 as part of a prospective, observational study of OHCA attended by 10 English NHS Ambulance Services. 28 729 OHCA cases had resuscitation attempted by Emergency Medical Services and were included in the study. Data linkage was carried out using a data linkage service provided by NHS Digital, a national provider of health-related data. To assess data linkage feasibility a random sample of 3120 cases was selected. The sample was securely transferred to NHS Digital to be matched using OHCAO patient demographic data to return previously missing demographic data and provide ONS date of death data. Results A total of 2513 (80.5%) OHCAO cases were matched to patients in the NHS PDS database. Using the linkage process, missing demographic data were retrieved for 1636 (72.7%) out of 2249 OHCAO cases that had previously incomplete demographic data. Returned ONS date of death data allowed analysis of 30-day survival status. The results showed a 30-day survival rate of 9.3%, reducing unknown survival status from 46.1% to 8.5%. Conclusions In this sample, data linkage between the OHCAO registry and NHS PDS database was shown to be feasible, improving demographic data quality and allowing analysis of 30-day survival status. https://bmjopen.bmj.com/content/bmjopen/7/11/e017784.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/bmjopen-2017-017784
    • Derivation and internal validation of the screening to enhance prehospital identification of sepsis (SEPSIS) score in adults on arrival at the emergency department

      Smyth, Michael A.; Gallacher, Daniel; Kimani, Peter K.; Ragoo, Mark; Ward, Matthew; Perkins, Gavin D. (2019-07-16)
    • The Diagnostic accuracy of prehospital assessment of acute respiratory failure

      Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Herbert, Esther; Perkins, Gavin D.; Ward, Matthew; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Bradburn, Mike; et al. (2020-12-01)
      Acute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure. Methods: A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial. Adults with suspected ARF were recruited from the UK West Midlands Ambulance Service. The pre-hospital clinical impression of the recruiting ambulance service clinician was prospectively recorded and compared to the final hospital diagnosis at 30 days. Agreement between pre-hospital and hospital diagnostic assessments was evaluated using raw agreement and Gwets AC1 coefficient. Results: 77 participants were included. Chronic obstructive pulmonary disease (32.9%) and lower respiratory tract infection (32.9%) were the most frequently suspected primary pre-hospital diagnoses for ARF, with secondary contributory conditions recorded in 36 patients (46.8%). There was moderate agreement between the primary pre-hospital and hospital diagnoses, with raw agreement of 58.5% and a Gwets AC1 coefficient of 0.56 (95% CI 0.43 to 0.69). In five cases, a non-respiratory final diagnosis was present, including: myocardial infarction, ruptured abdominal aortic aneurysm, liver failure and sepsis. Conclusions: Pre-hospital assessment of ARF is challenging, with limited accuracy compared to the final hospital diagnosis. A syndromic approach, providing general supportive care, rather than a specifically disease-orientated treatment strategy, is likely to be most appropriate for the pre-hospital environment. Abstract published with permission.
    • The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials

      Perkins, Gavin D.; Kenna, Claire; Ji, Chen; Deakin, Charles D.; Nolan, Jerry P.; Quinn, Tom; Fothergill, Rachael; Gunson, Imogen; Pocock, Helen; Rees, Nigel; et al. (2019-07)
    • European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation

      Perkins, Gavin D.; Handley, Anthony J.; Koster, Rudolph W.; Castren, Maaret; Smyth, Michael A.; Olasveengen, Theresa; Monsieurs, Koenraad G.; Raffay, Violetta; Grasner, Jan-Thorsten; Wenzel, Volker; et al. (2015-10)
    • Identification of adults with sepsis in the prehospital environment: a systematic review

      Smyth, Michael A.; Brace-McDonnell, Samantha J.; Perkins, Gavin D. (2016-08)
      Objective: Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. Design: Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted. Setting: Prehospital/emergency medical services (EMS). Study selection: All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS. Outcome measures: Recognition of sepsis by EMS clinicians. Results: Owing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool. Conclusions: Recognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit. https://bmjopen.bmj.com/content/bmjopen/6/8/e011218.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/bmjopen-2016-011218
    • Identification of Sepsis among Ward Patients

      Smyth, Michael A.; Daniels, Ron; Perkins, Gavin D. (2015)
    • Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK

      McQueen, Carl; Crombie, Nicholas; Perkins, Gavin D.; Wheaton, Steve (2014-10)
      Introduction In the West Midlands region of the UK, the delivery of prehospital trauma care has recently been remodelled through the introduction of a regionalised major trauma network (MTN). Helicopter emergency medical services (HEMS) are integral to the network, providing means of delivering highly skilled specialist teams to scenes of trauma and rapid transfer of patients to major trauma centres. This study reviews the impact of introducing the West Midlands MTN on the operation of one its regional HEMS units. Methods Retrospective review of the Midlands Air Ambulance clinical database for the 6 months after the launch of the West Midlands MTN. The corresponding period for the previous year was reviewed for comparison. The contribution of trauma cases to overall workload, mission outcome data and the number of interventions performed at the scene were compared. Results The proportion of HEMS activations for trauma cases was similar in both cohorts (70.84% before MTN vs 71.57% after MTN). The proportion of mission cancellations was significantly lower after the launch of the network (23.71% vs 19.03%). Significantly more scene attendances resulted in interventions by HEMS crews after the MTN launch (44.66% vs 56.92%). Conclusions Since the introduction of the West Midlands MTN, tasking of HEMS assets appears to be better targeted to cases involving significant injury, and a reduction in mission cancellations has been observed. There is a need for more detailed evaluation of patient outcomes to identify strategies for optimising the utilisation of HEMS assets within the regional network. https://emj.bmj.com/content/emermed/31/10/844.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-2013-202756
    • Improving data quality in a UK out-of-hospital cardiac arrest registry through data linkage between the Out-of-Hospital Cardiac Arrest Outcomes (OHCAO) project and NHS Digital

      Rajagopal, Sangeerthana; Booth, Scott; Brown, Terry P.; Ji, Chen; Hawkes, Claire A.; Siriwardena, Aloysius; Kirby, Kim; Black, Sarah; Spaight, Robert; Gunson, Imogen; et al. (2017-09)
    • Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial

      Nolan, Jerry P.; Deakin, Charles D.; Ji, Chen; Gates, Simon; Rosser, Andy; Lall, Ranjit; Perkins, Gavin D. (2020-01-30)
    • Locations of out-of-hospital cardiac arrests and public-access defibrillators in relation to schools in an English ambulance service region

      Benson, Madeleine; Brown, Terry P.; Booth, Scott; Achana, Felix; Price, Gill; Ward, Matthew; Hawkes, Claire A.; Perkins, Gavin D. (2018-09)
    • Mechanical CPR: Who? When? How?

      Poole, Kurtis; Couper, Keith; Smyth, Michael A.; Yeung, Joyce; Perkins, Gavin D. (2018-05)