• The A2Z of Immediate Care

      Walker, Alison (2011-08)
    • “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 neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England

      Brown, Terry P.; Booth, Scott; Hawkes, Claire A.; Soar, Jasmeet; Mark, Julian; Mapstone, James; Fothergill, Rachael; Black, Sarah; Pocock, Helen; Bichmann, Anna; et al. (2019-01-01)
    • 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)
    • A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures

      Irving, Andy; Turner, Janette; Marsh, Maggie; Broadway-Parkinson, Andrea; Fall, Daniel; Coster, Joanne; Siriwardena, Aloysius (2018-02)
    • Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1)

      Dickson, Jon M.; Taylor, Louise H.; Shewan, Jane; Baldwin, Trevor; Grünewald, Richard A.; Reuber, Markus (2016-02)
      Objectives: Suspected seizures are a common reason for emergency calls to ambulance services. Prehospital management of these patients is an important element of good quality care. The aim of this study, conducted in a regional ambulance service in the UK, was to quantify the number of emergency telephone calls for suspected seizures in adults, the associated costs, and to describe the patients’ characteristics, their prehospital management and their immediate outcomes. Design: Quantitative cross-sectional study using routinely collected data and a detailed review of the clinical records of a consecutive series of adult patients (≥16 years). Setting: A regional ambulance service within the National Health Service in England. Participants: Cross-sectional data from all 605 481 adult emergency incidents managed by the ambulance service from 1 April 2012 to 31 March 2013. We selected a consecutive series of 178 individual incidents from May 2012 for more detailed analysis (132 after exclusions and removal of non-seizure cases). Results: Suspected seizures made up 3.3% of all emergency incidents. True medical emergencies were uncommon but 3.3% had partially occluded airways, 6.8% had ongoing seizure activity and 59.1% had clinical problems in addition to the seizure (29.1% involving injury). Emergency vehicles were dispatched for 97.2% of suspected seizures, the seizure had terminated on arrival in 93.2% of incidents, 75% of these patients were transported to hospital. The estimated emergency management cost per annum of suspected seizures in the English ambulance services is £45.2 million (€64.0 million, $68.6 million). Conclusions: Many patients with suspected seizures could potentially be treated more effectively and at lower cost by modifying ambulance call handling protocols. The development of innovative care pathways could give call handlers and paramedics alternatives to hospital transportation. Increased adoption of care plans could reduce 999 calls and could increase the rates of successful home or community treatment. https://bmjopen.bmj.com/content/bmjopen/6/2/e010573.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/bmjopen-2015-010573
    • Effectiveness of FAST campaign 2009 in South Yorkshire

      Kini, M.; Venables, Graham; Randall, Marc; Ryan, T.; Crossley, J. (2012-12-06)
    • 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
    • Is it time to change? The use of intranasal fentanyl for severe pain in the pre-hospital setting

      Parkinson, Martin (2014-11)
      Abstract published with permission. The treatment of pain is a commonplace issue for today’s paramedics, where the need for new analgesics to overcome cannulation barriers is gathering momentum. Intranasal fentanyl has proven itself to be a very safe and effective form of analgesia that overcomes those barriers and can help paramedics provide a higher standard of care. Although research into its use in the prehospital environment is still limited, evidence of its effectiveness in the accident and emergency department has highlighted its potential for helping paramedics treat severe pain where venous access is compromised. Studies have shown that intranasal fentanyl compares with the analgesic standard set by intravenous morphine and is rapidly becoming the drug of choice in the paediatric accident and emergency department.
    • Medical and prehospital care training in UK fire and rescue services

      Walker, Alison; Robson, Brian (2010-12)
      We 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
    • Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

      Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, Aloysius (2017-01)
    • Non-invasive ventilation as a prehospital intervention for acute COPD exacerbation

      McCreesh, Samuel (2019-09-11)
      Abstract published with permission. Chronic obstructive pulmonary disease (COPD) is the second most common respiratory illness in the UK, affecting over 1 million people. Acute exacerbations of COPD are a common presentation to the ambulance service and account for thousands of hospital admissions annually. Acute respiratory failure accompanies approximately 20% of exacerbations. Current prehospital treatment focuses on oxygen and pharmacological therapy to treat the underlying causes. Non-invasive ventilation (NIV) is a method of ventilatory support that does not require endotracheal intubation, avoiding significant risks associated with intubation and sedation. While some UK ambulance services have introduced NIV, UK guidelines primarily focus on hospital use. International trials have shown prehospital NIV to be more effective than standard treatment in terms of reducing the need for intubation and invasive ventilation in hospital. However, further research is necessary before NIV is introduced widely in UK prehospital paramedic practice.
    • Paramedic Pathfinder: is it really better than current practice?

      Goulding, James (2014-08)
      Abstract published with permission. Following the recent publication of an article on the Paramedic Pathfinder in the Emergency Medicine Journal, James Goulding argues that rather than highlighting a step forward for the paramedic profession, it serves as an indication that there needs to be more rigorous research before a change in current methods can be recommended.
    • Prehospital emergency anaesthesia: time taken to care for and respond to a critically injured patient

      Blinkhorn, Anthony (2019-07-10)
      The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Trauma: Who Cares? report recommended that people trained to administer anaesthesia and intubate severely injured patients should be available in prehospital environments. Published articles, reference documents and guidance reports were reviewed to compare the management plans and standard operating procedures produced by an ambulance trust in England that provides prehospital emergency anaesthesia (PHEA). Documents reviewed all provide a common un-referenced patient injury list showing indications to perform PHEA but do not state a time frame within which it should be performed. No minimum time before PHEA is started and how long is acceptable to wait for a specialist resource to arrive before an ambulance can transport to a hospital were found. Further work is required to establish and formalise this time frame. Abstract published with permission.
    • Prehospital management of a patient with severe sepsis

      Boardman, Sue; Richmond, Chris; Robson, Wayne; Daniels, Ron (2013-09-29)
      Paramedics have made a significant contribution to reductions in mortality for the time-critical conditions of acute myocardial infarction (AMI) and major trauma (Myocardial Ischaemia National Audit Project (MINAP), 2008), and they will be instrumental in helping to reduce stroke mortality in the near future (Department of Health 2006). These improvements have, and will be achieved by pre-hospital diagnosis and prompt aggressive treatment. There is however another time critical condition that is currently not being targeted, in which pre-hospital staff could significantly improve the patient’s chances of survival. This condition is severe sepsis. This article presents a case study of a patient with severe sepsis who is transported from a nursing home to the emergency department (ED), and explores how paramedics can diagnose severe sepsis by use of a screening tool, and discusses the practicalities of delivering evidence-based care en route to hospital (high concentration oxygen, intravenous fluid challenges, intravenous antibiotics, measuring blood lactate). The benefits of alerting the receiving hospital of a patient with severe sepsis are also discussed. Abstract published with permission.
    • A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

      Platt, Anthony (2020-06-01)
      Background: In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology. Methods: All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data. Results: 478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%). Conclusion: Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival. Abstract published with permission.
    • Severe hypoglycaemia is a frequent reason for 999 calls in Yorkshire

      James, Cathryn; Scott, A. R.; Walker, Alison; Clapham, Linda (2010-03)