• A randomized trial of epinephrine in out-of-hospital cardiac arrest

      Perkins, Gavin D.; Ji, Chen; Deakin, Charles D.; Quinn, Tom; Nolan, Jerry P.; Scomparin, Charlotte; Regan, Scott; Long, John; Slowther, Anne-Marie; Pocock, Helen; et al. (2018-08)
    • RePHILL: protocol for a randomised controlled trial of pre-hospital blood product resuscitation for trauma

      Smith, Iain M.; Crombie, Nicholas; Bishop, J.R.; McLaughlin, A.; Naumann, David N.; Herbert, M.; Hancox, James M.; Slinn, G.; Ives, N.; Grant, M.; et al. (2018-10)
    • A review of the annual case epidemiology and clinical exposure of 45 paramedics, in a UK ambulance service: a service evaluation

      Rosser, Andy (2020-10)
      Ambulance services are facing increased demand to provide both urgent and emergency care. Details of a paramedic’s case load, patient mix and interventions delivered during patient encounters within contemporary practice are rarely described within the literature. This paper provides insight into the work of paramedics within an NHS ambulance service within the UK; the frequency of low, medium and high acuity clinical presentations, amongst patients they care for and the utilisation of clinical interventions in practice. https://emj.bmj.com/content/37/10/e8.3 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.16
    • Seizures in the prehospital setting

      Cashmore, Jamie (2010-07)
      Seizures are a common occurrence in the prehospital arena, however, with numerous conditions causing seizures, prehospital clinicians can be left with a dilemma in the treatment of these patients. Patients who are actively seizing will predominately have their airway maintained, oxygen administered and therapeutic intervention (diazepam) initiated. One form of seizure, non-epileptic attack disorder or psychogenic seizures, are often called ‘pseudo’ seizures—an acronym synonymous in the ambulance service, this gives connotations that the patient is ‘faking it’. However, these patients often have deep psychological trauma that needs careful handling and empathy. Abstract published with permission.
    • Self-directed learning: Does it affect team performance?

      Smythe, Mike; Perkins, Gavin D. (2011-03)
    • 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.
    • Stabilisation and transfer of sick new-borns delivered in stand-alone midwifery led units

      Tyler, W.; Philpott, A.; Brown, S.; Rhodes, J. (2014-06)
      Background Women should be offered the choice of delivering at home, in midwife-led units (MLU) or obstetric units.1 20% of Shropshire mothers choose delivery in an MLU which refer into Shrewsbury and Telford NHS Trust (SaTH) obstetric/neonatal unit for additional care. The West Midlands neonatal transfer service (WMNTS) is not commissioned to transfer babies from MLUs; any transfer required is performed by the MLU midwife and the West Midlands Ambulance Service (WMAS). These staff must be confident in recognising, stabilising and transferring babies requiring a higher level of care at or immediately after delivery. Aim To develop an educational package for midwives and paramedics caring for sick newborns. Project Representatives from midwifery, neonatal care, WMAS and WMNTS met to develop a training package. They were informed by the Scottish Transport Team who deliver a course for their remote maternity units. Support for the project was given by SaTH, WMAS and WMNTS. A one day programme was delivered at Shrewsbury MLU in December 2013. Feedback 16 midwives and 4 paramedics attended the course. All lectures, workshops and simulations were rated as good (20%) or excellent (80%). The course was rated as excellent (95%) or good (5%). Further developments Dates are set for three additional courses. All staff supporting stand-alone MLUs will access this training on a two-yearly basis. This programme will be offered to other MLUs in the West Midlands. https://fn.bmj.com/content/fetalneonatal/99/Suppl_1/A27.1.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/archdischild-2014-306576.75
    • Storytelling via social media in the ambulance services

      Cotton, Mark; MacGregor, Murray; Warner, Claire; Bateson, Fiona (2019-09-11)
    • Stress and cardiopulmonary resuscitation performance

      Smyth, Mike; Perkins, Gavin D. (2011-02)
    • ‘They are not silly people – they know the difference’: clinician focus group views on a pilot randomised controlled trial of prehospital continuous positive airway pressure (CPAP)

      Miller, Joshua; Keating, Samuel; Scott, Alex; 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), nine trial-trained paramedics took part in three semi-structured focus groups. 204 trained staff had been given the opportunity to take part. The sample included six staff who had recruited to the trial, one who had not, and two who had withdrawn from it. Audio-recordings were transcribed and analysed thematically. Results Participants described facilitators to trial participation including: clear eligibility criteria and patient documentation, access to demonstration equipment, training away from the work environment, and repeated patient recruitment. Barriers to taking part included: the lack of protected time for training, inadequate workplace facilities for the electronic learning package used, adverse responses by receiving hospital staff, and infrequent patient exposure. Both paramedics who withdrew cited the inconvenience of carrying packs each shift. Some participants described anxiety and distress when opening packs to find a standard-care mask, and reported patients having similar reactions. Conclusions Future researchers could promote improved workplace computing facilities and increased provision of face-to-face training days, which were praised by participants in these focus groups, but limited to a single event distant from some staff. Greater stakeholder engagement by researchers could reduce the difficulties at hospital handover reported by some ambulance staff. Where blinding is not possible, the perceptions of clinicians and patients should be considered carefully, as this study shows both may have adverse emotional responses to being treated with standard care, particularly when prospective consent discussions describe the trial intervention as potentially beneficial., https://emj.bmj.com/content/36/10/e12.2 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.28
    • Tia prehospital referral feasibility trial (TIER): recruitment and intervention usage

      Rees, Nigel; Hampton, C.; Bulger, Jenna; Ali, K.; Quinn, Tom; Ford, Gary A.; Akbari, Ashley; Ward, Matthew; Porter, Alison; Jones, Colin; et al. (2018-04)
      Aim Early specialist assessment of Transient Ischaemic Attack (TIA) can reduce the risk of stroke and death. We assessed feasibility of undertaking a multi-centre cluster randomised trial to evaluate clinical and cost effectiveness of referral of patients attended by emergency ambulance paramedic with low-risk TIA directly to specialist TIA clinic for early review. Method We randomly allocated volunteer paramedics to intervention or control group. Intervention paramedics were trained to deliver the intervention during the patient recruitment period. Control paramedics continued to deliver care as usual. Patients with TIA were identified from hospital records. Results Development and recruitment phases are complete, with outcome follow up ongoing. Eighty nine of 134 (66%) paramedics participated in TIER. Of 1377 patients attended by trial paramedics during the patient recruitment period, 53 (3.8%) were identified as eligible for trial inclusion. Three of 36 (8%) patients attended by intervention paramedics were referred to the TIA clinic. Of the others, only one appeared to be a missed referral; in one case there was no prehospital record of TIA; one was attended by a paramedic who was not TIER trained; one patient record was missing; all others were recorded with contraindications: FAST positive (n=13); ABCD2 score >3 (n=5); already taking warfarin (n=2); crescendo TIA (n=1) other clinical factors (n=8). Conclusion Preliminary results indicate challenges in recruitment and low referral rates. Further analyses will focus on whether progression criteria for a definitive trial were met, and clinical outcomes from this feasibility trial. https://bmjopen.bmj.com/content/8/Suppl_1/A28.1 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/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.73
    • Tourniquets in the treatment of prehospital haemorrhage

      Bond, Reiss (2018-11)
      Abstract published with permission. Background: During recent conflicts in Iraq and Afghanistan, tourniquets were a useful tool in the management of non-compressible prehospital catastrophic haemorrhage. Recommendations for use within the civilian setting were then made. However, civilian research supporting this change in practice is limited. Aims: The aim of the research is to evaluate the utility of prehospital tourniquet application through description of the complications associated with use, as well as identification of mortality following prehospital application. Methods: A literature search was completed using PubMed and Embase for research studies on prehospital tourniquet use in extremity trauma. Study relevance was confirmed via their abstracts and final selection was made through reviewing the full publication. Data were extracted on mortality, complications, indication for use, effective application and application duration of tourniquet use. This was tabulated, and a descriptive analysis performed. Results: The research reported a mortality range of 3–14% with an associated complication rate of 2.1–32.4%. The effectiveness of prehospital application was in the 88.8–98.7% range, with tourniquet application durations of 48–103.2 minutes. Conclusions: The tourniquet should continue to be available to UK paramedics for the management of prehospital non-compressible catastrophic haemorrhage. Application is likely to provide a mortality benefit with limited morbidity and associated complications.