• 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
    • 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.
    • Stress and cardiopulmonary resuscitation performance

      Smyth, Mike; Perkins, Gavin D. (2011-02)
    • Self-directed learning: Does it affect team performance?

      Smythe, Mike; Perkins, Gavin D. (2011-03)
    • 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
    • Evaluation of the use of portfolios in paramedic practice: part 1

      Armitage, Ewan (2011-05)
      Abstract published with permission. 2009 saw the first audit of paramedic portfolios by the Health Professions Council (HPC) and later this year, the second national audit will take place. In the first of a two-part evaluation of the use of portfolios in paramedic practice, the history of professional portfolios is chartered including their current position within the paramedic profession. A number of contemporary issues with portfolios are identified, including format and how they relate to a paramedic's continuing professional development. The impact of the Knowledge and Skills Framework on portfolio use is also discussed.
    • Hepatitis C

      Malpas, Michael (2011-05)
    • Evaluation of the use of portfolios in paramedic practice: part 2

      Armitage, Ewan (2011-06)
      Abstract published with permission. This second of a two-part evaluation on the use of portfolios in paramedic practice, focuses on what constitutes evidence of a paramedic's competence and ultimate fitness to practice. A variety of evaluation models are identified to help in this process and this is developed further with reference to some educational theories. In the final part of the evaluation, the author proposes a number of recommendations concerning the use of portfolios within the paramedic profession and draws on the issues identified in the first part of the evaluation to summarize the current position of paramedic portfolios.
    • Occupational Emergency Medicine

      Armitage, Ewan (2011-06)
    • Hospital Emergency Response Teams

      Armitage, Ewan (2011-07)
    • Management of the ruptured abdominal aortic aneurysm: challenges facing paramedics

      Smith, Neil (2011-07)
      Abstract published with permission. An abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta resulting from degenerative cardiovascular disease. Such aneurysmal arteries pose few problems for many patients and are simply monitored and managed conservatively within the community. However, the ruptured abdominal aortic aneurysm is a time-critical medical emergency requiring timely surgical intervention in order to offer any chance of survival. Even when recognized early, 90% of patients will suffer an out-of-hospital cardiac arrest before arriving at the emergency department and of those who reach theatre, only 40% will survive. This article aims to increase the paramedic practitioner's knowledge and understanding of AAA through a holistic discussion of the prehospital recognition and early management. Particular emphasis will be placed on fluid replacement therapy and analgesia with specific reference to the issues associated with aggressive fluid resuscitation, and the potential benefits elicited through the use of opiate analgesia and subsequent pharmacologically induced hypotension. This article further aims to set the prehospital management into the wider context, thus providing paramedic practitioner's with an insight into how prehospital interventions affect the patients’ ultimate outcome and postoperative quality of life.
    • ABC of Patient Safety

      Armitage, Ewan (2011-10)
    • Sickle cell disease: acute complications and management

      Hodges, Ross (2011-11)
      Abstract published with permission. Sickle cell disease is a genetic blood disorder resulting in the sickling of red blood cells (RBC) when exposed to certain conditions. Historically, sickle cell care has been poor and often delayed, but in recent years, several key publications have helped provide guidance and uniformity on how to manage acute crises, ensuring all patients receive a high level of care. The sickling of RBC can lead to acute complications, some of which are potentially life-threatening. The sickling can occur anywhere in the body, producing a wide array of symptoms. For this reason, it is paramount that prehospital clinicians conduct a thorough assessment and, where appropriate, initiate treatment prior to arrival at the hospital. The most common symptom that clinicians will need to manage is severe pain. Many patients will have an individualized treatment plan detailing how they are best managed following an acute crisis and where possible it should be followed.
    • Prehospital reflections: diagnosing apnoea at a multiple casualty chemical, biological, radiological and nuclear incident

      Malpas, Michael (2011-12)
      During a multiple casualty chemical, biological, radiological and nuclear incident it is imperative that triage is accurately undertaken to use resources effectively and give the greatest chance of survival to those who need it. This reflection explores an option to assist in this matter by proposing a colorimetric breathing detection system, while remembering that this it is untested, may be a useful aid. https://emj.bmj.com/content/emermed/28/12/1061.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.2011.113019