• Awareness of CPR-induced consciousness by UK paramedics

      Mays, Ben; Gregory, Pete; Sudron, Ceri; Kilner, Tim (2019-06-01)
    • Clinical guidelines — one year on

      Irving, Steve; Millins, Mark (2014-01)
    • 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.
    • Improving post-resuscitation care after out-of-hospital cardiac arrest

      Fisher, Ruth (2020-01)
      Abstract published with permission. Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres. Methods: Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes. Results: Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur. Conclusion: Further research into specific care pathways and centralised care should be carried out, and an OHCA postresuscitation care pathway should be developed to improve the delivery of care and survival.
    • 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
    • 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