• Introduction of non-transport guidelines into an ambulance service: a retrospective review

      Gray, J.T.; Wardrope, Jim (2007-10)
      Recent government policy has looked at improving the role of ambulance services in delivering alternative care models for patients. https://emj.bmj.com/content/24/10/727. 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 10.1136/emj.2007.048850
    • Avoiding admissions from the ambulance service: a review of elderly patients with falls and patients with breathing difficulties seen by emergency care practitioners in South Yorkshire

      Gray, J.T; Walker, A. (2008-02-25)
      To determine the true impact of emergency care practitioners (ECPs) on admissions relative to emergency department (ED) attendance. https://emj.bmj.com/content/25/3/168 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/emj.2007.050732
    • Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial

      Dixon, S.; Mason, Suzanne; Knowles, Emma; Colwell, B.; Wardrope, Jim; Snooks, Helen; Gorringe, R.; Perrin, J.; Nicholl, Jon (2009-05-22)
      Background: A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK. Objectives: To assess the cost effectiveness of the paramedic practitioner (PP) scheme compared with usual emergency care. Methods: A cluster randomised controlled trial was undertaken of PP compared with usual care. Weeks were allocated to the study group at random to the PP scheme either being active (intervention) or inactive (control). Resource use data were collected from routine sources, and from patient-completed questionnaires for events up to 28 days. EQ-5D data were also collected at 28 days. Results: Whereas the intervention group received more PP contact time, it reduced the proportion of emergency department (ED) attendances (53.3% vs 84.0%) and time in the ED (126.6 vs 211.3 minutes). There was also some evidence of increased use of health services in the days following the incident for patients in the intervention group. Overall, total costs in the intervention group were £140 lower when routine data were considered (p = 0.63). When the costs and QALY were considered simultaneously, PP had a greater than 95% chance of being cost effective at £20 000 per QALY. Conclusion: Several changes in resource use are associated with the use of PP. Given these economic results in tandem with the clinical, operational and patient-related benefits, the wider implementation and evaluation of similar schemes should be considered. https://emj.bmj.com/content/26/6/446. 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.2008.061424
    • Is referral to emergency care practitioners by general practitioners in-hours effective?

      Gray, J.T.; Walker, A. (2009-07-22)
      Objective: To evaluate the cost effectiveness to primary care trusts (PCT) in commissioning general practitioner (GP) referrals in-hours to emergency care practitioners (ECP). Methods: A retrospective case note review for patients referred by GPs in-hours to ECP over a 4-month period to ascertain any added value over a GP visit. Results: In a 4-month period 105 patients were referred. In most cases (90.5%) the ECP was utilised as a substitute for a GP rather than providing any additional skills. Defining an avoided attendance as the ECP undertaking an intervention outside a GP skill set this equated to a 9.5% avoided attendance rate compared with the ECP service standard rate of 60%. This has implications both in terms of financial benefit and ongoing ECP service sustainability. Conclusions: There is little value in a PCT commissioning this service as they will pay twice and care must be taken in accepting new referral streams into existing services. https://emj.bmj.com/content/26/8/611. 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.2008.059956
    • Mobile Radiography at a Music Festival

      Walker, A.; Brenchley, J.; Hughes, N. (2009-07-22)
      Limb injuries are common at music festival sites and traditionally patients seen by on-site medical services require referral to hospital emergency departments for radiographic exclusion of bony injury. This takes clinical personnel off site, increases demand on local emergency departments and is inconvenient for revellers. This is an audit of the use of a portable digital radiography system at the Virgin music festival in Staffordshire over a 3-year period. https://emj.bmj.com/content/26/8/613. 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.2008.059006
    • “At the sharp end”: does ambulance dispatch data from south Yorkshire support the picture of increased weapon-related violence in the UK?

      Gray, J.T.; Walker, A. (2009-09-22)
      Objective: To assess whether ambulance responses in South Yorkshire to stabbing, gunshot, penetrating trauma cases have increased over the past few years, supporting the observed increase in media reporting. Methods: A review was undertaken of the frequency with which the ambulance medical priority dispatch system card 27 (stab/gunshot/penetrating trauma) was used, grouped by financial year, and comparison made over time and by patient age group. Results: There is a steady increase in the number of occurrences of these cases and also an increase in the percentage made up by the 10–29 year age group. Conclusions: Ambulance data from South Yorkshire support the media conclusion that there is an increase in stabbing, gunshot and penetrating trauma as well as an increase in the proportion of younger victims. This has wider implications for ambulance staff and the UK as a whole; however, these calls remain a low percentage of overall ambulance service activity. https://emj.bmj.com/content/26/10/741. 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.2008.067298
    • Characteristics of people from Leeds with severe hypoglycaemia requiring emergency services intervention in the home

      james, cathryn; Scott, A. R.; Walker, Alison; Ajjan, Ramzi A.; Clapham, Linda (2010-03)
    • Does the pandemic medical early warning score system correlate with disposition decisions made at patient contact by emergency care practitioners?

      Gray, J.T.; Challen, K; Oughton, L (2010-11-13)
      Objective To assess the performance of the pandemic medical early warning score (PMEWS) in a cohort of adult patients seen in the community by emergency care practitioners (ECP) and its correlation with ECP decision-making to either ‘treat and leave’ or transfer for hospital assessment. Methods Cases attended by ECP in South Yorkshire in 2007 in which the final ECP working diagnosis was a respiratory condition were retrospectively identified from the Yorkshire Ambulance Service database. The patient report forms were reviewed for the PMEWS variables and scores calculated using the PMEWS system. The outcome measure was management in the community versus transport to hospital. Receiver operating characteristics (ROC) curves were calculated to assess the discrimination of PMEWS. Results A cohort of 300 patients was assessed. 217 (72%) were aged 65 years or over, and 272 (91%) had either comorbid disease or impaired functional status. 98 (33%) were deemed to need hospital assessment or admission. The ROC curves suggested that there is good correlation between the PMEWS score and the decision to discharge. Conclusions PMEWS correlates well with decisions to admit to hospital or leave at home made by extended role practitioners in the patient group studied; however, further prospective work is required to further validate early warning scoring systems in prehospital care. https://emj.bmj.com/content/27/12/943 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.2011.113019
    • The role of ambulance clinicians in management and leadership

      Taylor, James (2011-01)
      Abstract published with permission. Ambulance clinicians are ‘professional problem solvers’. As such, they share much in common with managers within organizations, and have much to offer in terms of the contribution that they can make to the management and leadership of the organisations within which they work. This article highlights the importance of management and leadership development opportunities being made available for ambulance clinicians. A practical approach is advocated, whereby ‘hybrid roles’ are developed to enable individuals to gain practical experience of management and leadership within a structured and supportive environment, while retaining an element of clinical practice. A case study is used to illustrate the article, based upon the author's own career within the NHS to date which has combined both management and clinical practice with structured management and leadership development. Practical advice is offered for those ambulance clinicians who may be interested in undertaking such development in future, or who wish to explore further their role as clinical leaders.
    • National swine flu adult assessment guidelines: retrospective validation of objective criteria in three proxy datasets

      Challen, K.; Bentley, A.; Bright, J.; Gray, J.; Walter, D. (2011-04)
      OBJECTIVES: To validate the objective criteria in the Department of Health Adult Swine Flu Assessment Tool against proxy datasets for pandemic influenza. DESIGN: Comparative validation study with 3 datasets. SETTING: Urban Emergency Department (group 1) and prehospital care (groups 2 and 3). PARTICIPANTS: Adults with community-acquired pneumonia (group 1, n=281), shortness of breath (group 2, n=211) or any respiratory diagnosis (group 3, n=300). OUTCOME MEASURES: Hospital admission (group 1), hospital admission or intravenous therapy (group 2) and transfer to emergency department (group 3). RESULTS: Sensitivity and specificity of the tool were 0.73 (95% CI 0.67 to 0.8) and 0.83 (0.72 to 0.9) in group 1, 0.64 (0.55 to 0.71) and 0.63 (0.52 to 0.73) in group 2 and 0.84 (0.75 to 0.9) and 0.55 (0.48 to 0.62) in group 3. Analysis of individual components of the tool and a summative score is presented. CONCLUSIONS: The objective criteria of the proposed DH assessment tool do not perform particularly well in predicting relevant clinical outcomes in feasible proxy conditions for pandemic influenza. https://emj.bmj.com/content/emermed/28/4/287.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.2009.083683
    • A mannequin study comparing suitability of the i-gel™ with a laryngeal mask airway device

      Mark, Julian; Walker, Alison; Davey, Christine (2011-08)
      Abstract published with permission. Objectives: To compare the suitability of the i-gel™ (Intersurgical Ltd, UK) supraglottic airway device with a single-use laryngeal mask airway (LMA) in the hazardous area response team (HART) environment and the urban search and rescue (USAR) environment. Method: five chemical, biological, radiological and nuclear trained urban search and rescue paramedics attempted five insertions of each supraglottic airway device into a Laerdal® ALS mannequin (Laerdal, Norway) in three separate environments: normal (supine, waist high), HART (wearing gas-tight suits and respirators) and USAR (in a simulated confined space). As a control group, five anaesthetists also attempted five insertions of each supraglottic airway device into a Laerdal® Airway Trainer (Laerdal, Norway) under normal conditions. Time from first touching the device to successful inflation of the mannequin's lungs’ using a self-inflating bag-valve device was recorded and operator opinion was captured using a four-point Likert scale. Results: insertion of the i-gel airway was significantly faster than insertion of the LMA in simulated USAR conditions (P<0.001), there was no significant difference in control conditions or when wearing gas-tight personal protective equipment. There was no difference in the number of attempts required to achieve correct placement of either supraglottic airway device in any situation. Conclusions: this study has demonstrated that, in simulated USAR conditions, the i-gel supraglottic airway device performs at least as well as the LMA and is significantly quicker to insert. The authors therefore recommend that the i-gel is introduced into the USAR HART environment with further clinical evaluation in this and other prehospital settings.
    • The A2Z of Immediate Care

      Walker, Alison (2011-08)
    • Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes

      Snaith, B.; Hardy, M.; Walker, Alison (2011-12)
      This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED. https://emj.bmj.com/content/emermed/28/12/1063.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.2010.096966
    • Elderly falls: a national survey of UK ambulance services

      Darnell, Gareth; Mason, Suzanne; Snooks, Helen (2012-12-29)
      Objective To provide a detailed description of the current UK ambulance service provision for older people who fall. Method National survey of UK ambulance services. Results 11/13 Ambulance services (84.6%) participated in this national survey. Conclusion This survey has highlighted the need for robust evidence to inform policy, service and practice development to improve the care of this vulnerable population. https://emj.bmj.com/content/29/12/1009 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/bmj.h535
    • Exploring the developmental need for a paramedic pathway to mental health

      Elliott, Ruth; Brown, Paul (2013-05)
      Abstract published with permission. The following article discusses an organisational development need of a national ‘Mental Health Pathway’ to enable paramedics to provide the appropriate care for people who present mental health issues. The Department of Health acknowledges the huge modernisation of the ambulance service in England and faster access to people with immediate life-threatening conditions; however, the service is also responding to an increasing number of patients who have an urgent primary care need, which includes mental distress, as opposed to clinical emergency. The Department of Health (2009) policy calls for a ‘new vision’, where the ambulance service could increase efficiency and effectiveness towards patients who are experiencing non life-threatening emergencies. The key aims are to form a programme of advancement to address both improving mental health and accessibility of services for people with poor mental health. The vision of the policy is that by 2020 mental and physical health will have equal priority. The development of a mental health pathway within the ambulance service may help to reduce admissions or re-attendance, while improving care for patients. An evidence-based approach is used to provide a balanced, logical and supported argument within a reflection of practice. This is evaluated against a hypothetical patient’s case study, which reflects common issues faced by paramedics and ambulance technicians. The analytical process considers patient, professional, organisational and multi-disciplinary team perspectives.
    • Clinical guidelines — one year on

      Irving, Steve; Millins, Mark (2014-01)
    • Is there scope for an observational pain scoring tool in paramedic practice?

      Harvey, Christopher (2014-02)
      Abstract published with permission. In the pre-hospital environment, attending an older person can pose many challenges, including a lack of a detailed history, polypharmacy and co-morbidities, as well as a lack of out-of-hours support to name but a few. These challenges are enhanced further when the patient is cognitively impaired by syndromes such as dementia. There appears to be very little research available into how the pain of older people with dementia is assessed and managed by paramedics. This article highlights a literature review that was carried out to explore the evidence base and possible implementation of the Abbey Pain Scale, with the view of conducting a study in the near future. Particular focus is made on the education and training required to implement the tool, other environments where it has been adopted, as well as benefits and limitations.
    • Developing leadership in the UK’s ambulance service: a review of the consultant paramedic role

      Hodge, Andrew (2014-03)
      Abstract published with permission. Background: This study seeks to understand part of the emerging clinical leadership framework implemented in the UK’s NHS ambulance services in recent years. The aim is to explore the relatively new role of consultant paramedics and understand their leadership activities in relationship to nationally determined requirements, and the challenges they face performing this crucial leadership role. Methods: Semi-structured interviews were conducted with all consultant paramedics in the UK in 2013. Thematic analysis and coding were used to analyse the data and identify emergent themes. Additionally, basic demographic data was collected for comparison against national requirements. Findings: The findings illustrated three key themes: credible clinical leadership, an emerging empowered profession, and role expectations. There is a clear indication that consultant paramedics are a key part of clinical leadership for the paramedic profession. However, they are challenged to remain clinically competent by undertaking regular clinical practice and providing visible leadership on the ground, while strategically taking the profession forward. Operational resistance and power issues were highlighted as some of the problems faced by these clinical leaders. Implications: The findings may prove useful for employers in reviewing their clinical leadership structures, and in workforce planning for future consultant paramedics. The paramedic profession and its professional body may equally find this study useful for informing future strategic planning.