• 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)
    • The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study

      Sheppard, James P.; Mellor, Ruth M.; Greenfield, Sheila; Mant, Jonathan; Quinn, Tom; Sandler, David; Sims, Don; Singh, Satinder; Ward, Matthew; McManus, Richard J.; et al. (2015-02)
      Background Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care. Objective Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway. Methods This was a cohort study of linked patient medical records. Consenting patients with a diagnosis of stroke were recruited from two urban hospitals. Data from patient medical records were extracted and entered into a Cox regression analysis to investigate the association between time to CT request and recording of onset time, stroke recognition (using the Face Arm Speech Test (FAST)) and sending of a prealert message. Results 151 patients (aged 71±15 years) travelled to hospital via ambulance and were eligible for this analysis. Time of symptom onset was recorded in 61 (40%) cases, the FAST test was positive in 114 (75%) and a prealert message was sent in 65 (44%). Following adjustment for confounding, patients who had time of onset recorded (HR 0.73, 95% CI 0.52 to 1.03), were FAST-positive (HR 0.54, 95% CI 0.37 to 0.80) or were prealerted (HR 0.26, 95% CI 0.18 to 0.38), were more likely to receive a timely CT request in hospital. Conclusions This study highlights the importance of hospital prealerting, accurate stroke recognition, and recording of onset time. Those not recognised with stroke in a prehospital setting appear to be excluded from the possibility of rapid treatment in hospital, even before they have been seen by a specialist. https://emj.bmj.com/content/32/2/93.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. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2013-203026
    • 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)
    • 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)
    • 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)
    • Out-of-hospital cardiac arrest termination of resuscitation with ongoing CPR: An observational study

      Yates, E.J.; Schmidbauer, S.; Smyth, A.M.; Ward, Matthew; Dorrian, S.; Siriwardena, Aloysius; Friberg, H.; Perkins, Gavin D. (2018-09)
    • Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation.

      Pandor, Abdullah; Thokala, Praveen; Goodacre, Steve; Poku, Edith; Stevens, John W.; Ren, Shijie; Cantrell, Anna; Perkins, Gavin D.; Ward, Matthew; Penn-Ashman, Jerry (2015-06)
    • Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study

      Sheppard, James P.; Lindenmeyer, A.; Mellor, Ruth M.; Greenfield, Sheila; Mant, Jonathan; Quinn, Tom; Rosser, Andrew; Sandler, David; Sims, D.; Ward, Matthew; et al. (2016-07)
      Background Thrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a ‘prealert’ message can significantly improve the timeliness of treatment. Objective Examine the prevalence of hospital prealerting, the extent to which prealert protocols are followed and what factors influence emergency medical services (EMS) staff’s decision to send a prealert. Methods Cohort study of patients admitted to two acute stroke units in West Midlands (UK) hospitals using linked data from hospital and EMS records. A logistic regression model examined the association between prealert eligibility and whether a prealert message was sent. In semistructured interviews, EMS staff were asked about their experiences of patients with suspected stroke. Results Of the 539 patients eligible for this study, 271 (51%) were recruited. Of these, only 79 (29%) were eligible for prealerting according to criteria set out in local protocols but 143 (53%) were prealerted. Increasing number of Face, Arm, Speech Test symptoms (1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001; 2 symptoms, OR 31.36, 95% CI 9.91 to 99.24, p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to 233.03, p<0.001) and EMS contact within 5 h of symptom onset (OR 2.99, 95% CI 1.37 to 6.50 p=0.006) were key predictors of prealerting but eligibility for prealert as a whole was not (OR 1.92, 95% CI 0.85 to 4.34 p=0.12). In qualitative interviews, EMS staff displayed varying understanding of prealert protocols and described frustration when their interpretation of the prealert criteria was not shared by ED staff. Conclusions Up to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke. https://emj.bmj.com/content/emermed/33/7/482.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-2014-204392
    • Tia prehospital referral feasibility trial (TIER): recruitment and intervention usage

      Rees, Nigel; Hampton, C.; Bulger, Jenna; Ali, Khalid; Quinn, Tom; Ford, Gary A.; Akbari, Ashley; Ward, Matthew; Porter, Alison; Jones, Colin; et al. (2018-04)
      Aim Early specialist assessment of Transient Ischaemic Attack (TIA) can reduce the risk of stroke and death. We assessed feasibility of undertaking a multi-centre cluster randomised trial to evaluate clinical and cost effectiveness of referral of patients attended by emergency ambulance paramedic with low-risk TIA directly to specialist TIA clinic for early review. Method We randomly allocated volunteer paramedics to intervention or control group. Intervention paramedics were trained to deliver the intervention during the patient recruitment period. Control paramedics continued to deliver care as usual. Patients with TIA were identified from hospital records. Results Development and recruitment phases are complete, with outcome follow up ongoing. Eighty nine of 134 (66%) paramedics participated in TIER. Of 1377 patients attended by trial paramedics during the patient recruitment period, 53 (3.8%) were identified as eligible for trial inclusion. Three of 36 (8%) patients attended by intervention paramedics were referred to the TIA clinic. Of the others, only one appeared to be a missed referral; in one case there was no prehospital record of TIA; one was attended by a paramedic who was not TIER trained; one patient record was missing; all others were recorded with contraindications: FAST positive (n=13); ABCD2 score >3 (n=5); already taking warfarin (n=2); crescendo TIA (n=1) other clinical factors (n=8). Conclusion Preliminary results indicate challenges in recruitment and low referral rates. Further analyses will focus on whether progression criteria for a definitive trial were met, and clinical outcomes from this feasibility trial. https://bmjopen.bmj.com/content/8/Suppl_1/A28.1 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/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.73