• 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).
    • Patient safety in ambulance services: a scoping review

      Fisher, Joanne D.; Freeman, Karoline; Clarke, Aileen; Spurgeon, Peter; Smyth, Mike; Perkins, Gavin D.; Sujan, Mark-Alexander; Cooke, Matthew W. (2015-05)
    • Patient safety in ambulance services: a scoping review

      Smyth, Michael A.; Fisher, Joanne D.; Freeman, Karoline; Clarke, Aileen; Spurgeon, Peter; Perkins, Gavin D.; Sujan, Mark-Alexander; Cooke, Matthew W. (2015-05)
    • Patient safety incidents and medication errors during a clinical trial: experience from a pre-hospital randomized controlled trial of emergency medication administration

      England, Ed; Deakin, Charles; Nolan, Jerry; Lall, Ranjit; Quinn, Tom; Gates, Simon; Miller, Joshua; O'Shea, Lyndsey; Pocock, Helen; Rees, Nigel; et al. (2020-06-14)
    • Patient-centred outcomes for prehospital trauma trials: A systematic review and patient involvement exercise

      Hancox, James M.; Toman, Emma; Brace-McDonnell, Samantha J.; Naumann, David N. (2019-01-06)
    • Physical health in mental health: considerations for paramedics

      Cromar-Hayes, Maxine; Seaton, Walter (2020-01)
      Abstract published with permission. Life expectancy for people with a mental illness diagnosis is 15–20 years less than those without, mainly because of poor physical health. Mental ill health affects a significant proportion of paramedics' patients, and practitioners could assess and promote their physical health even though contact time is limited. Factors affecting physical health include substandard and disjointed care, stigma and diagnostic overshadowing—where physical symptoms are dismissed as a feature of mental illness. Diagnostic overshadowing is not discussed in key paramedic literature, although patients with mental health problems are at risk of not having their physical needs being taken seriously. The paramedic's role in health promotion is receiving more attention. Making Every Contact Count (MECC)—a behaviour change model using brief interaction—could be adopted by paramedics to promote physical health, especially when linked to campaigns and local services. Health promotion is in its early days in paramedicine, and paramedics could learn from the experiences of other professions. (Abstract published with permission).
    • Post-admission outcomes of participants in the PARAMEDIC trial: a cluster randomised trial of mechanical or manual chest compressions

      Ji, Chen; Lall, Ranjit; Quinn, Tom; Kaye, Charlotte; Haywood, K.; Horton, Jessica; Gordon, V.; Deakin, Charles D.; Pocock, Helen; Carson, Andrew; et al. (2017-09)
    • PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol

      Alghamdi, Abdulrhman; Cook, Eloïse; Carlton, Edward; Siriwardena, Aloysius; Hann, Mark; Thompson, Alexander; Foulkes, Angela; Phillips, John; Cooper, Jamie; Steve, Bell; et al. (2019-10-07)
      Introduction Within the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test. We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting. Methods and analysis We will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment. Ethics and dissemination The study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Abstract, URL 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: 10.1136/bmjopen-2019-032834
    • Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation.

      Pandor, Abdullah; Thokala, Praveen; Goodacre, Steve; Poku, Edith; Stevens, John W.; Ren, Shijie; Cantrell, Anna; Perkins, Gavin D.; Ward, Matthew; Penn-Ashman, Jerry (2015-06)
    • Prehospital adrenaline administration for out-of-hospital cardiac arrest: the picture in England and Wales

      Booth, Scott; Ji, Chen; Soar, Jasmeet; Siriwardena, Aloysius; Fothergill, Rachael; Spaight, Robert; Perkins, Gavin D. (2018-09)
    • Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice

      McQueen, Carl; Crombie, Nicholas; Hulme, Jonathan; Cormack, Stef; Hussain, Nageena; Ludwig, Frank; Wheaton, Steve (2015-01)
      Introduction In the West Midlands region of the UK, delivery of pre-hospital care has been remodelled through introduction of a 24 h Medical Emergency Response Incident Team (MERIT). Teams including physicians and critical care paramedics (CCP) are deployed to incidents on land-based and helicopter-based platforms. Clinical practice, including delivery of rapid sequence induction of anaesthesia (RSI), is underpinned by standard operating procedures (SOP). This study describes the first 12 months experience of prehospital RSI in the MERIT scheme in the West Midlands. Methods Retrospective review of the MERIT clinical database for the 12 months following the launch of the scheme. Data was collected relating to the number of RSIs performed; indication for RSI; number of intubation attempts; grade of view on laryngoscopy and the base speciality/grade of the operator performing intubation. Results MERIT teams were activated 1619 times, attending scene in 1029 cases. RSI was performed 142 times (13.80% of scene attendances). There was one recorded case of failure to intubate requiring insertion of a supraglottic airway device (0.70%). In over a third of RSI cases, CCPs performed laryngoscopy and intubation (n=53, 37.32%). Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians (74.70%) and CCPs (77.36%). Intubation was successful at the first attempt in over 90% of cases. Conclusions This study demonstrates that operation within a system that provides high levels of exposure, underpinned by comprehensive and robust training and governance frameworks, promotes levels of performance in successful prehospital RSI regardless of base speciality or profession. https://emj.bmj.com/content/32/1/65.long 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-2013-202890
    • 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.
    • Prehospital continuous positive airway pressure for acute respiratory failure: the ACUTE feasibility RCT

      Fuller, Gordon W.; Keating, Samuel; Goodacre, Steve; Herbert, Esther; Perkins, Gavin; Rosser, Andy; Gunson, Imogen; Miller, Joshua; Ward, Matthew; Bradburn, Mike; et al. (2021-02)
    • 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.
    • Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

      Gates, Simon; Lall, Ranjit; Quinn, Tom; Deakin, Charles D.; Cooke, Matthew W.; Horton, Jessica; Lamb, Sarah E.; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andrew; et al. (2017-04)