• 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
    • ‘Have you had the surgery?’: A survey of transgender and non-binary patients’ experiences of interacting with the ambulance service

      Barley, Chloé; Tooms, Alec (2019-09-24)
      Background Pre-hospital research around the experience of transgender and non-binary (TNB) patients is scarce, with existing articles lacking input from TNB patients. This research aimed to collate TNB patients’ experiences of interacting with the ambulance service. A secondary aim was to gather TNB patients’ opinions regarding the education of ambulance clinicians on TNB health issues. Method An online-based, mixed-methods survey was created. A range of free text, multiple choice and Likert-scaled questions were used. Advertisement on social media was tailored to target TNB individuals who have had patient contact with the ambulance service. All respondents were anonymous and voluntary. This survey was conducted by TNB individuals in a personal capacity, without funding. Results 72% of the 25 respondents rated their experience as satisfactory or above. 40% reported that identifying as TNB affected the way they were treated and 40% reported that they were asked about their gender by the ambulance crew. In free text answers, the main themes identified were the misidentification of gender, the use of incorrect pronouns, hospital handovers, intrusive/irrelevant questioning and the need for training. Conclusions The responses suggest that TNB patients feel that being asked about their gender is important however ambulance staff sometimes struggled to address this sensitively. Positive experiences included having gender and pronouns addressed in hospital handover which can form a recommendation for best practice. Negative experiences were associated with being misgendered, using incorrect pronouns and intrusive/irrelevant questioning. Survey responses led to practical recommendations for ambulance staff interacting with TNB patients, including the authors creating a training session which has received positive feedback from clinicians. Limitations include small sample size, potential for response bias due to survey being self-selecting and missing demographic data. Recommendations for further research are to provide a more in-depth exploration of TNB experience and of ambulance staff views., https://emj.bmj.com/content/36/10/e2.2. 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/emermed-2019-999abs.2
    • Hepatitis C

      Malpas, Michael (2011-05)
    • History taking, assessment and documentation for paramedics

      Jenkins, Steven (2013-06)
      Abstract published with permission. Paramedic practice is progressing at a more rapid pace now than at any time in its history. Paramedics need to align their method of assessing patients to integrate into the multi-disciplinary team involved in the patient's journey of care and treatment. The review of systems (RoS) approach is widely used and accepted in healthcare, and easily assimilates into paramedic practice. RoS improves patient care by holistically assessing the patient, and can make the inter-professional handover of a patient to another team more professionally acceptable. Documentation using the RoS is more comprehensive and less prone to errors.
    • Honouring inclusivity and support in paramedicine

      Deakins, Ash; Jones-Keyte, Leigh; Brown, Pam (2019-01-12)
    • Hospital Emergency Response Teams

      Armitage, Ewan (2011-07)
    • ‘I wish there was CPAP in every box’: internet-based survey responses of clinicians recruiting to a pilot randomised controlled trial of continuous positive airway pressure (CPAP) for patients with acute respiratory failure

      Miller, Joshua; Keating, Samuel; Fuller, Gordon W.; Goodacre, Steve (2019-09-24)
      Background Continuous positive airway pressure (CPAP) is not in widespread use in UK ambulance services, but could benefit patients with acute respiratory failure (ARF). As a new treatment in this context, clinician acceptability is an important factor in the feasibility of conducting definitive research in the prehospital arena. Methods As part of a pilot randomised controlled trial (the ACUTE study), recruiting clinicians were emailed after enrolling patients to either the CPAP or standard-care arm, and were asked to complete an optional, anonymous, internet-based survey. The survey used a mixture of closed questions, Likert-scaled answers and free text to explore staff views on both the treatment and the trial procedures. Quantitative responses were analysed descriptively, and qualitative answers thematically. Results Recruiting clinicians for all 77 patients were sent survey links, with 40 email responses received. Respondents felt confident diagnosing ARF and determining trial eligibility. CPAP-arm respondents found the equipment easy-to-use and felt it did not delay transport to hospital. Most standard-care respondents said they would have liked CPAP to be available to their patients. Respondents described varying responses from receiving hospital staff. Conclusions Prehospital CPAP seems acceptable to clinicians. Limitations of this survey are that it was targeted only at clinicians who have already opted to take part in the trial, and so may exclude a body of staff who find the treatment unacceptable at face value. Not all clinicians who enrolled patients completed the survey, which could suggest a response bias or simply a reflection of its optional nature within the trial. Future pilot studies could mandate an acceptability survey, and also seek the views of staff not taking part in the interventional study. Trial teams may need to better explain the rationale of comparing a new intervention with standard care, and offer more widespread hospital staff awareness sessions., https://emj.bmj.com/content/36/10/e11.2 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/emermed-2019-999abs.25
    • 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 J.; Brown, Terry P.; Ji, Chen; Hawkes, Claire A.; Siriwardena, Aloysius; Kirby, Kim; Black, Sarah; Spaight, Robert; Gunson, Imogen; et al. (2017-09)
    • Incidence of acute respiratory failure cases in West Midlands Ambulance Service (WMAS) – sub-study of ACUTE (ambulance CPAP: use, treatment effect and economics) trial

      Gunson, Imogen M.; Herbert, Esther; Fuller, Gordon W. (2019-09-24)
      Background Acute respiratory failure (ARF) is a life-threatening emergency and pre-hospital CPAP may improve outcomes. A CPAP cost-effectiveness determinant is the incidence of eligible patients with ARF. This sub-study of the ACUTE trial aimed to determine the number of adults with ARF potentially suitable for CPAP, presenting to WMAS. Methods This observational study was conducted between 1stAugust 2017 and 31st July 2018. Adult patients presenting with SpO2 <94% were identified from WMAS electronic patient records. Electronic filters applied ACUTE trial inclusion and exclusion criteria, with subsequent manual clinical review by a research paramedic. A second research paramedic checked a sub-sample for inter-rater agreement. Overall and monthly incidence rates were calculated, census data provided the population denominator. Results 108,391 potential patients were identified from electronic patient records (EPR), after filter application 4,526 cases were eligible for review (Figure 1). After review, 1017 cases were considered CPAP candidates. Inter-rater agreement was 86%. Overall incidence was 17.35 per 100,000 population per year (95%CI 16.3–18.5). Marked seasonal variation was present, increasing over winter (Figure 2). Urban areas had the highest proportion of eligible patients (67.6% v 18.3% Rural v 14.2% semi-rural); and 53.0% of all eligible were male. Conclusions The incidence of eligible ARF patients impacts on the cost-effectiveness of pre-hospital CPAP, but previous reports have been variable, using sub-optimal methods or from non-UK settings. We report a valid NHS estimate of 17 patients per 100,000 who do not respond to current pre-hospital ARF management and could be candidates for CPAP., https://emj.bmj.com/content/36/10/e11.3. 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. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.26
    • Infrastructure and operating processes of PIONEER, the HDR-UK Data Hub in Acute Care and the workings of the Data Trust Committee: a protocol paper

      Gallier, Suzy; Price, Gary; Pandya, Hina; McCarmack, Gillian; James, Chris; Ruane, Bob; Forty, Laura; Crosby, Benjamin; Atkin, Catherine; Evans, Ralph; et al. (2021-04)
      Health Data Research UK designated seven UK-based Hubs to facilitate health data use for research. PIONEER is the Hub in Acute Care. PIONEER delivered workshops where patients/public citizens agreed key principles to guide access to unconsented, anonymised, routinely collected health data. These were used to inform the protocol. https://informatics.bmj.com/content/28/1/e100294 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/bmjhci-2020-100294
    • ‘Interception’: a model for specialist prehospital care provision when helicopters are not available

      McQueen, Carl; Apps, Richard; Mason, Fay; Crombie, Nicholas; Hulme, Jon (2013-11)
      The deployment of specialist teams to incident scenes by helicopter and the delivery of critical care interventions such as Rapid Sequence Induction of anaesthesia to patients are becoming well-established components of trauma care in the UK. Traditionally in the UK, Helicopter Emergency Medical Services (HEMS) are limited to daylight operations only. The safety and feasibility of operating HEMS services at night is a topic of debate currently in the UK HEMS community. Within the West Midlands Major Trauma Network, the Medical Emergency Response Incident Team (MERIT) provides a physician-led prehospital care service that responds to incidents by air during daylight hours and by Rapid Response Vehicle during the hours of darkness. The MERIT service is coordinated and supported by a dedicated Major Trauma Desk manned by a HEMS paramedic in the ambulance service control room. This case illustrates the importance of coordination and integration of specialist resources within a major trauma network to ensure the expedient delivery of HEMS-level care to patients outside of normal flying hours. https://emj.bmj.com/content/emermed/30/11/956.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-2013-202989