• An alternative care pathway for suspected seizures in pre-hospital care: a service evaluation

      Dickson, Jon M.; Rawlings, Gregg H.; Grünewald, Richard A.; Miles, Kate; Mack, Carina; Heywood, Thomas; Reuber, Markus (2017-09)
      Abstract published with permission. Introduction ‐ An uncomplicated, self-limiting epileptic seizure in a patient with an established diagnosis of epilepsy usually requires only first aid, but in the UK it is estimated that 75% of these patients are transported to hospital and many are discharged without review or follow-up with an epilepsy specialist. Alternative care pathways have the potential to reduce unnecessary conveyance to hospital and to improve rates of epilepsy specialist follow-up, and thereby increase the quality and cost effectiveness of care. Methods ‐ A service evaluation of a new alternative care pathway in a regional ambulance service in the UK. The alternative care pathway allowed paramedics to refer eligible patients to an epilepsy specialist nurse service. Results ‐ The ambulance service managed 3964 suspected seizure incidents in the study period (1 July 2015‐31 May 2016), of which 22.5% (891/3964) were potentially eligible for the alternative care pathway. Of the potentially eligible incidents, 9.8% (87/891) were referred. The 87 incidents were generated by 74 individual patients. A total of 97.3% (71/73) patients were contacted within the target time of five days, the average time taken for each phone call was 10 minutes and the average additional work load generated by each call was 10 minutes. There was a positive outcome in 55% (48/87) of incidents. Conclusions ‐ An alternative care pathway for people after a suspected seizure has the potential to safely reduce rates of transport to hospital and to improve care for people with epilepsy. However, paramedics in our study used the alternative care pathway for only a small proportion of those patients who were potentially eligible. Further research is required to develop tools to support paramedics to confidently identify patients that are suitable for management without transport to hospital.
    • Paramedic perceptions of the feasibility and practicalities of prehospital clinical trials: a questionnaire survey

      Hargreaves, Kate; Goodacre, Steve; Mortimer, Peter (2014-06)
      Background Clinical trials are required to strengthen the evidence base for prehospital care. This questionnaire study aimed to explore paramedics’ perceptions of prehospital research and barriers to conducting prehospital clinical trials. Methods A self-completed questionnaire was developed to explore paramedic perceptions and barriers to undertaking prehospital trials based upon a review of existing research and semistructured qualitative interviews with five paramedics. The questionnaire was distributed by ‘research champions’ to 300 paramedics at randomly selected ambulance stations in Yorkshire. Results Responses were received from 96/300 participants (32%). Interest in clinical trials was reported, but barriers were recognised, including perceptions of poor knowledge and limited use of evidence, that conducting research is not a paramedics’ responsibility, limited support for involvement in trials, concerns about the practicalities of randomisation and consent, and time pressures. No association was found between training route and perceived understanding of trials (p=0.263) or feeling that involvement in trials was a professional responsibility (p=0.838). Previous involvement in prehospital research was not associated with opinions on importance of an evidence base (p=0.934) or gaining consent (p=0.329). The number of years respondents had been practicing was not associated with opinions on personal experience versus scientific evidence (p=0.582) or willingness to receive training for clinical trials (p=0.111). However, the low response rate limited the power of the study to detect potential associations. Conclusions Paramedics reported interest and understanding of research, but a number of practical and ethical barriers were recognised that need to be addressed if prehospital clinical trials are to increase. https://emj.bmj.com/content/emermed/31/6/499.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/emermed-2013-202346