• 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)
    • 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
    • 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
    • Clinical suspicion regarding needle decompression for patients with chest trauma

      Beaven, Alastair; Harrison, James; Porter, Keith; Steyn, Richard (2019-08-07)
      Abstract published with permission. Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.
    • 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)
    • Cost-effectiveness of out-of-hospital continuous positive airway pressure for acute respiratory failure: decision analytic modelling using data from a feasibility trial

      Thokala, Praveen; Fuller, Gordon W.; Goodacre, Steve; Keating, Samuel; Herbert, Esther; Perkins, Gavin; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Ward, Matthew; et al. (2021-01-25)
    • 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 J.; 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.
    • Did West Midlands ambulance service paramedics’ usage of adrenaline change after the publication of the paramedic2 results, but prior to any guideline change? A service evaluation

      Gunson, Imogen M. (2020-10)
      This project evaluated whether practice change occurred amongst Paramedics directly after the publication of the PARAMEDIC2 trial, regarding adrenaline administration during out-of-hospital cardiac arrest (OHCA) without a change in guidelines. When Paramedics are exposed to a seminal publication there is anecdotal concern their autonomous practice changes, based on comprehension of findings ahead of potential guideline changes, however little evidence appraises whether this really occurs. https://emj.bmj.com/content/37/10/e4.3 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-2020-999abs.7
    • Disaster rules

      Armitage, Ewan (2011-03)