• Evolution of triage systems

      Robertson-Steel, Iain (2006-01-26)
      The French word "trier", the origin of the word "triage", was originally applied to a process of sorting, probably around 1792, by Baron Dominique Jean Larrey, Surgeon in Chief to Napoleon's Imperial Guard. Larrey was credited with designing a flying ambulance: the Ambulance Volante. Baron Francois Percy also contributed to the organisation of a care system for the ongoing management of casualties. Out of the French Service de Santé, not only emerged the concept of triage, but the organisational structure necessary to handle the growing number of casualties in modern warfare. http://dx.doi.org/10.1136/emj.2005.030270 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
    • Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy

      Woollard, Malcolm; Mannion, W.; Lighton, D.; Johns, I.; O'Meara, P.; Cotton, C.; smyth, mike (2007-10)
    • Airtraq vs standard laryngoscopy by student paramedics and experienced prehospital laryngoscopists managing a model of difficult intubation

      Woollard, Malcolm; Lighton, M; Mannion, W.; Watt, J.; McCrea, C.; Johns, I.; Hamilton, L.; O'Meara, P.; Cotton, C.; smyth, mike (2008-01)
    • An introduction to CPD for paramedic practice

      Sibson, Lynda (2008-11)
      This article outlines the concept of continuing professional development (CPD) and its application to the paramedic. CPD has long been an aspect of other health care professions, but is relatively new to the paramedic profession. The Health Professions Council (HPC) standards mean that paramedics will have to provide evidence of CPD from August 2009. The standards apply not only to those in clinical practice, but also to those working in research, management or education. CPD can initially appear daunting. However, it can, and should be, an enjoyable aspect of developing yourself and your professional practice. This article therefore aims to suggest some CPD activities for paramedic practice, with reference to some of the HPC guidelines and learning from other health care professionals. Abstract published with permission.
    • A guide to reading scientific journal articles

      Sibson, Lynda (2008-11)
      This article provides an overview of how to read and review a journal article for a range of purposes. Articles are read for a variety of reasons, such as to support the review of a specific subject area, for a research study or academic research. Reading articles on a regular basis will not only improve your academic reading skills but also will begin to develop your skills in critical analysis of journal articles and their application to practice. A breakdown is provided of different aspects of an article with some suggested questions to ask in order to ensure that you get the most from the article. Several types of journal article are outlined, including case studies, literature reviews and research articles. Also highlighted are some of the pitfalls when reading articles and suggestions for ways to develop confidence in critical reading and share expertise and experience to inform clinical practice. Abstract published with permission.
    • An introduction to reflective practice

      Sibson, Lynda (2008-12)
      This article aims to describe the process and theory of reflective practice and outline some reflective practice models for consideration for paramedic practice. Reflective practice is not just about writing an assignment, it is about looking back (reflecting) on a situation and taking another objective view of the incident. Reflective learning is a process where examination and exploration of an issue of concern, triggered by a specific experience, is clarified into some form of meaning, thus changing the individuals' perspective. Four reflective models have been presented—each with similar steps—so that readers can chose which one suits their practice. If undertaken well, it can enhance and develop new knowledge, initiate changes to practice and ultimately, improve patient care. Abstract published with permission.
    • Clinical feedback to ambulance crews: supporting professional development

      Jenkinson, Emma; Hayman, T.; Bleetman, A. (2009-03-23)
      Ambulance crew involvement in patient care traditionally ends with handover of the patient at the emergency department (ED). We found that ambulance staff often asked informal questions about patients during subsequent visits. We therefore introduced a formal feedback service for ambulance crews in June 2005. This was initially run by a medical student, funded jointly by the trust and the West Midlands Ambulance Service. It is now run by an acute care practitioner. https://emj.bmj.com/content/26/4/309.1. 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/emj.2007.053868
    • Haemorrhage from femoral vein cannula: an additional potential source of haemorrhage among intravenous drug users

      Cooke, R.; Fitzpatrick, J. (2009-08-21)
      Use of the femoral vein for self-administration of drugs is increasing among intravenous drug users. We report an unusual source of haemorrhage in an habitual intravenous drug user involved in trauma. https://emj.bmj.com/content/26/9/675. 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.2008.071175
    • Prehospital pleural decompression: a new way? : a new approach

      Mursell, Ian (2009-11)
      Needle thoracocentesis is the current UK ambulance services sole method of pleural decompression in suspected tension pneumothorax; however, the effectiveness of this procedure is questionable. This article will discuss the viability of an alternative method of pleural decompression—tube thoracostomy—providing comparisons to needle decompression and other current techniques used in prehospital care. The efficacy and safety of available techniques will be critically analysed and recommendations for the assessment and management of tension pneumothorax will be provided. Abstract published with permission.
    • Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial

      Rawlins, Lettie; Woollard, Malcolm; Williams, Julia; Hallam, Phil (2009-12-14)
      Objectives To determine whether listening to music during cardiopulmonary resuscitation (CPR) training increases the proportion of lay people delivering chest compressions of 100 per minute. Design Prospective randomised crossover trial. Setting Large UK university. Participants 130 volunteers (81 men) recruited on an opportunistic basis. Exclusion criteria included age under 18, trained health professionals, and cardiopulmonary resuscitation (CPR) training within the past three months. Interventions Volunteers performed three sequences of one minute of continuous chest compressions on a skill meter resuscitation manikin accompanied by no music, repeated choruses of Nellie the Elephant (Nellie), and That’s the Way (I like it) (TTW) according to a pre-randomised order. Main outcome measures Rate of chest compressions delivered (primary outcome), depth of compressions, proportion of incorrect compressions, and type of error. Results Median (interquartile range) compression rates were 110 (93-119) with no music, 105 (98-107) with Nellie, and 109 (103-110) with TTW. There were significant differences within groups between Nellie v no music and Nellie v TTW (P<0.001) but not no music v TTW (P=0.055). A compression rate of between 95 and 105 was achieved with no music, Nellie, and TTW for 15/130 (12%), 42/130 (32%), and 12/130 (9%) attempts, respectively. Differences in proportions were significant for Nellie v no music and Nellie v TTW (P<0.001) but not for no music v TTW (P=0.55). Relative risk for a compression rate between 95 and 105 was 2.8 (95% confidence interval 1.66 to 4.80) for Nellie v no music, 0.8 (0.40 to 1.62) for TTW v no music, and 3.5 (1.97 to 6.33) for Nellie v TTW. The number needed to treat for listening to Nellie v no music was 5 (4 to 10)—that is, the number of cardiac arrests required during which lay responders listen to Nellie to facilitate one patient receiving compressions at the correct rate (v no music) would be between four and 10. A greater proportion of compressions were too shallow when participants listened to Nellie v no music (56% v 47%, P=0.022). Conclusions Listening to Nellie the Elephant significantly increased the proportion of lay people delivering compression rates at close to 100 per minute. Unfortunately it also increased the proportion of compressions delivered at an inadequate depth. As current resuscitation guidelines give equal emphasis to correct rate and depth, listening to Nellie the Elephant as a learning aid during CPR training should be discontinued. Further research is required to identify music that, when played during CPR training, increases the proportion of lay responders providing chest compressions at both the correct rate and depth. https://www.bmj.com/content/339/bmj.b4707. 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/bmj.b4707
    • Prehospital care: the case of the misplaced tube

      Mursell, Ian (2010-03)
      This article critically reviews a fictional case study regarding a misplaced tracheal tube that was initially unrecognized despite a rigorous assessment to verify placement. It critically reviews the evidence surrounding verification techniques, tracheal tube securing and the principles of legal and ethical responsibility in patient handovers and transfer of care. Abstract published with permission.
    • Mentorship for paramedic practice: bridging the gap

      Sibson, Lynda; Mursell, Ian (2010-06)
      In the second of a series of four articles on mentorship for paramedic practice, this article focuses on the aspect of the assessment of competence and how these relate to everyday clinical practice in term of mentorship. The article will also address the concept of competence and performance and how these two concepts can be applied to bridging the theory-practice gap that can often be the cause of poor learning and subsequent inadequate clinical practice. Abstract published with permission.
    • Clinical leadership in the ambulance service

      Walker, Alison; Sibson, Lynda; Marshall, Andrea (2010-06-18)
      Ambulance Services in England have recently launched the Report of the National Steering Group on Clinical Leadership in the Ambulance Service. This is the first document specifically reviewing the roles and development of Clinical Leadership, at all levels, for UK ambulance service clinicians. The document covers an evidence-based review of clinical leadership principles outlined in key policy documents, publications and systems; a strategic framework for clinical leadership in ambulance service; and includes examples of good current practice in ambulance service clinical leadership and development Clinical leadership has been referred to in a number of key policy documents; most notably, Taking Healthcare to the Patient: Transforming NHS Ambulance Services (DH 2005) made a number of recommendations of which Recommendation 62 is the most relevant to this document. “There should be improved opportunity for career progression, with scope for ambulance professionals to become clinical leaders. While ambulance trusts will always need clinical direction from a variety of specialties, they should develop the potential of their own staff to influence clinical developments and improve and assure quality of care.” This report focuses on putting theory into practice, a proposed clinical leadership ladder and a clinical leadership self-assessment tool for individuals and organisations. Some clinical leadership examples are also included. The completed report was formally launched at the Ambulance Leadership Forum (English ambulance services, with participation for Clinical Leadership from the other UK ambulance services) in April 2009 and will pave the way for the development of the Ambulance Service National Future Clinical Leaders Group. This national pilot, involving all the UK NHS ambulance services, will comprise of staff with paramedic backgrounds who will receive leadership development to work with the CEOs and Directors of Clinical Care groups to progress clinical quality and clinical leadership development in the ambulance service. https://emj.bmj.com/content/27/6/490.2. 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.2009.078915
    • Seizures in the prehospital setting

      Cashmore, Jamie (2010-07)
      Seizures are a common occurrence in the prehospital arena, however, with numerous conditions causing seizures, prehospital clinicians can be left with a dilemma in the treatment of these patients. Patients who are actively seizing will predominately have their airway maintained, oxygen administered and therapeutic intervention (diazepam) initiated. One form of seizure, non-epileptic attack disorder or psychogenic seizures, are often called ‘pseudo’ seizures—an acronym synonymous in the ambulance service, this gives connotations that the patient is ‘faking it’. However, these patients often have deep psychological trauma that needs careful handling and empathy. Abstract published with permission.
    • Stress and cardiopulmonary resuscitation performance

      Smyth, Mike; Perkins, Gavin D. (2011-02)
    • Emergency surgery

      Armitage, Ewan (2011-02)
    • Keeping the beat: does music improve the performance of chest compression by lay persons?

      Rawlins, Lettie; Woollard, Malcolm; Hallam, Phil; Williams, Julia (2011-03)
      Background Early bystander cardiopulmonary resuscitation (CPR) increases survival from out-of-hospital cardiac arrest. Simplifying training can improve skill retention and confidence. A recent pilot study suggested music may help health professionals perform CPR. The song ‘Nellie the Elephant’ (tempo 100 bpm) is sometimes used to encourage compression rates in accordance with Resuscitation Council guidelines. This study investigates whether music helps lay persons perform compressions at 100 per minute. Methods This randomised cross-over trial opportunistically recruited lay volunteers who performed three sequences, pre-randomised for order, of one minute of continuous chest compressions on a recording manikin accompanied by no music (NM) and repeated choruses of ‘Nellie the Elephant’ (Nellie), and ‘That's The Way (I Like It)' (TTW). Results Of 130 participants, 62% were male, median age was 21 (IQR 20 to 25), 72% had no previous CPR training. Mode and IQR for compression rate were NM 111 (93 to 119); Nellie 106 (98 to 107), (TTW) 109 (103 to 110). Within-groups differences were significant for Nellie vs NM and Nellie vs TTW (p<0.001) but not NM vs TTW (p=0.055). A compression rate of 95 to 105 was achieved with NM, Nellie, and TTW for 15/130 (12%), 42/130 (32%) and 12/130 (9%) attempts respectively. Differences in proportions were significant for Nellie vs. NM and Nellie vs TTW (p<0.0001) but not for NM vs TTW (p=0.55). Relative ‘risk’ for compression rate between 95 and 105 was 2.8 for Nellie vs NM (95%CI 1.66 to 4.80), 0.8 for TTW vs NM (95% CI 0.40 to 1.62), and 3.5 for Nellie vs. TTW (95% CI 1.97 to 6.33). Conclusion and recommendations ‘Listening to Nellie’ (vs TTW or no music) significantly increased the proportion of lay persons achieving compression rates close to the 100 bpm guideline. Playing it during training and ‘real’ CPR may help rescuers deliver correct compression rates. https://emj.bmj.com/content/emermed/28/3/e1.18.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/emj.2010.108605.6
    • Self-directed learning: Does it affect team performance?

      Smythe, Mike; Perkins, Gavin D. (2011-03)
    • Disaster rules

      Armitage, Ewan (2011-03)