• 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
    • Leadership within the ambulance service: rhetoric or reality?

      Taylor, James; Armitage, Ewan (2012-08)
      Abstract published with permission. Just as part 1 of this article (Armitage and Taylor, 2012) introduced the concept of management and leadership, specifically within the context of the ambulance service, part 2 will stimulate further discussion in connection with the development of leadership related knowledge, skills, experience and behaviours among paramedics. Throughout the piece, the need for leadership development at an organisational and professional level will be promoted, and the authors will explore why leadership and leadership development is a key component to paramedic practice, as well as considering how ‘human factors’ and ‘non-technical’ skills are central to a sucessful process of leadership. The NHS Leadership Framework will be reviewed and the authors will consider how it can be used by individuals, organisations and the paramedic profession as a whole to drive leadership development in the future.
    • Lecture notes: emergency medicine

      Armitage, Ewan (2011-12)
    • Legal and professional boundaries: a case study

      Hodgson, Ruth (2016-02)
      Abstract published with permission. There are multiple legal issues which dominate the work of paramedics and healthcare professionals alike. For those professionally registered, such as paramedics, there is an added obligation of professional boundaries. This article will examine possible legal and issues within a hypothetical case study and discuss the possible conflicts associated with these issues. The article considers a range of legal and professional aspects which may crop up in the pre-hospital care environment including capacity to consent, informed consent, acting in the best interests of a patient, rights of a foetus, infant preservation, duty of care and negligence. Within pre-hospital care there is a necessity to make rapid decisions based upon these laws, and therefore it is important that all practitioners consider these.
    • Lights, camera, disciplinary action?

      Mursell, Ian (2012-02)
      Abstract published with permission. There seldom appears to be a day go by without the opportunity to watch ourselves or colleagues in the latest episode of ‘Emergency Hero Rescues’ or similar ‘real life’ television programmes. However, the growth of such shows and inherent public interest in the emergency services brings to light the question of whether such media coverage is of benefit or risk to our profession. For many of us, watching such programmes is a guilty pleasure, we don't want to watch, but are strangely drawn to them. How many times have you found yourself ‘tutting’ at the TV or shaking your head pointing out the error of our peer's actions? Regardless of our reactions to such programmes, public interest is difficult to deny and as such, television coverage of prehospital care is a subject for careful consideration.
    • 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)
    • 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.
    • Mechanical CPR: Who? When? How?

      Poole, Kurtis; Couper, Keith; Smyth, Michael A.; Yeung, Joyce; Perkins, Gavin D. (2018-05)
    • Mechanical devices for chest compression: to use or not to use?

      Couper, Keith; Smyth, Michael A.; Perkins, Gavin D. (2015-06)
    • Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC) : a pragmatic, cluster randomised controlled trial

      Perkins, Gavin D.; Lall, Ranjit; Quinn, Tom; Deakin, Charles D.; Cooke, Matthew W.; Horton, Jessica; Lamb, Sarah E.; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andy; et al. (2015-03)
    • Medical Emergency Workload of a Regional UK HEMS Service.

      McQueen, Carl; Crombie, Nicholas; Cormack, Stef; Wheaton, Steve (2015-05)
    • 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.
    • Occupational Emergency Medicine

      Armitage, Ewan (2011-06)
    • 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)
    • Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome

      Perkins, Gavin D.; Brace, Samantha J.; Smythe, Mike; Ong, Giok; Gates, Simon (2012-04)
      Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited. https://heart.bmj.com/content/heartjnl/98/7/529.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/heartjnl-2011-300802
    • Paramedic treatment — wherever that may be?

      Price, James (2014-01)
      Abstract published with permission. James Price is Chair of the HART National Operations Group and HART Manager for West Midlands Ambulance Service NHS Foundation Trust, explains areas of operation and types of PPE used by the programme, and the challenges in delivering clinical care within the Inner Cordon.
    • PaRAMeDIC: a randomized controlled trial of a mechanical compression device

      Smyth, Mike (2012-01)
      Abstract published with permission. Survival from out-of-hospital cardiac arrest (OHCA) is influenced by the quality of cardiopulmonary resuscitation (CPR). However, research shows that in the out-of-hospital environment, and particularly during ambulance transport, CPR quality is frequently sub-optimal. Mechanical compression devices can deliver high quality CPR, yet there is an absence of high quality evidence to demonstrate improved clinical or cost effectiveness outcomes. The PaRAMeDIC trial will compare manual CPR with mechanical CPR in adult patients with non-traumatic OHCA. Objectives: the primary objective is to evaluate the effectiveness of mechanical chest compressions using the LUCAS (Lund University Cardiopulmonary Assistance System)-2 on mortality at 30 days post-OHCA. Secondary objectives include survived event (return of spontaneous circulation at hospital admission), quality of life and cognitive function at 3 and 12 months, survival at 12 months and cost effectiveness. Method: the trial is a pragmatic, cluster randomized controlled trial. Ambulance vehicles are randomized to control or LUCAS arms. Patient allocation is determined by the first ambulance vehicle which arrives first on scene (manual CPR vehicle or LUCAS CPR vehicle). The trial will assess the clinical and cost effectiveness of the LUCAS-2 device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942).