Browsing Publications - Yorkshire Ambulance Service by Journal Title "Emergency Medicine Journal : EMJ"
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Does the pandemic medical early warning score system correlate with disposition decisions made at patient contact by emergency care practitioners?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/emermed/27/12/943.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.2009.072959
Medical and prehospital care training in UK fire and rescue servicesWe were interested to see the paper by Quinn et al1 in this month's EMJ. We undertook a similar survey published in the EMJ in 2005 on the Fire Service management of burns,2 which concentrated on burns but also reviewed general levels of clinical training and skills within the Fire and Rescue Services (FRS), also with a response rate of over 70%. At the time 44/62 services had trained all their firefighters in the delivery of supplementary oxygen (71%), and it seems in some areas there is little change in skills, as in this paper 72% of responding services trained firefighters to provide supplementary oxygen. We also found similar levels of involvement in clinical training from both local hospitals and other prehospital organisations including NHS Ambulance Trusts. Since the publication of both our paper and that of Lee and Porter3 in 2007, the UK FRS through the Chief Fire Officers Association (CFOA) have been working to standardise prehospital immediate care provided by UK firefighters. This work has been looking at ways to develop a minimum standard of knowledge and application that satisfies the demanding requirements of both the FRS and the Health and Safety Executive. A further area for development has been in considering effective Clinical Governance systems; an area which the FRS has had little previous involvement. The work has recently been given project status by the Department for Communities and Local Government (CLG), the government department responsible for the FRS. In London, excellent results have been seen in a pilot project (Immediate Emergency Care), in which the London Fire Brigade (LFB) have worked closely with London Ambulance Service (LAS) in all aspects of the delivery of training, operational and clinical governance policies and procedures, and shared equipment protocols. The pilot is now being rolled out to all operational staff across LFB and has been made available to other regions as a working model. It is widely accepted that the natural partners for the FRS are NHS Ambulance Trusts. The main objective of the CLG project is to consider whether the progress made in London can be duplicated across the UK, reducing the requirement for FRS to rely on commercially driven or locally produced training. Initial indications suggest that this can be delivered. The Faculty of Prehospital Care has also supported developments in FRS Immediate Care. In summary, a great deal of work has already been completed, with more in development, around immediate emergency care by the UK Fire and Rescue Services. https://emj.bmj.com/content/27/12/960.2. 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/emj.2009.081828