Now showing items 1-20 of 112

    • Severe hypoglycaemia is a frequent reason for 999 calls in Yorkshire

      James, Cathryn; Scott, A. R.; Walker, Alison; Clapham, L. (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. (2010-12)
      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 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
    • Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study

      Jones, Matthew; Snooks, Helen; Bulger, Jenna; Watkins, Alan; Moore, Chris; Edwards, Adrian; Evans, Birdie A.; Fuller, Gordon; John, Ann; Benger, Jonathan; et al. (2019-01-14)
      Background Opioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN). Methods We propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up. Results We will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline. Conclusions THN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions. https://emj.bmj.com/content/36/1/e10.1. 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/emermed-2019-999.24
    • Clinical leadership in the ambulance service

      Walker, Alison; Sibson, Lynda; Marshall, Andrea (2010-06-18)
      Ambulance Services in England have recently launched the Report of the National Steering Group on Clinical Leadership in the Ambulance Service. This is the first document specifically reviewing the roles and development of Clinical Leadership, at all levels, for UK ambulance service clinicians. The document covers an evidence-based review of clinical leadership principles outlined in key policy documents, publications and systems; a strategic framework for clinical leadership in ambulance service; and includes examples of good current practice in ambulance service clinical leadership and development Clinical leadership has been referred to in a number of key policy documents; most notably, Taking Healthcare to the Patient: Transforming NHS Ambulance Services (DH 2005) made a number of recommendations of which Recommendation 62 is the most relevant to this document. “There should be improved opportunity for career progression, with scope for ambulance professionals to become clinical leaders. While ambulance trusts will always need clinical direction from a variety of specialties, they should develop the potential of their own staff to influence clinical developments and improve and assure quality of care.” This report focuses on putting theory into practice, a proposed clinical leadership ladder and a clinical leadership self-assessment tool for individuals and organisations. Some clinical leadership examples are also included. The completed report was formally launched at the Ambulance Leadership Forum (English ambulance services, with participation for Clinical Leadership from the other UK ambulance services) in April 2009 and will pave the way for the development of the Ambulance Service National Future Clinical Leaders Group. This national pilot, involving all the UK NHS ambulance services, will comprise of staff with paramedic backgrounds who will receive leadership development to work with the CEOs and Directors of Clinical Care groups to progress clinical quality and clinical leadership development in the ambulance service. https://emj.bmj.com/content/27/6/490.2. 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.2009.078915
    • A project to improve system performance and patient flow in the emergency operations centre in identification of high risk silver trauma service users who have suffered a traumatic head injury

      Faqir, Islam (2018-07-01)
      Major trauma or MT has historically and traditionally been associated as a disease mainly affecting young men, normally under the age of 401 (NAO 2010). Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability2 (Keogh et al. 2015). Nationally the population is growing older, it is anticipated that the elderly will form an increasing part of the major trauma work load. A recent report published by TARN3 2017, found that elderly trauma currently accounts for 20% of patients, the predominant reason was a fall from <2 metres. The Emergency Operations Centre or EOC reported call demand for the year ending 2016 was 8 55 015 (YAS BI, 2017). All calls receive a code dependent on chief complaint calls that coded 17 (falls) accounted for 82 847 of that call volume, just under 7000 calls a month. Calls that code 17 (green) has the potential of a 90 delay in call back from a clinician at times this can be prolonged further dependent on call demand within the EOC. https://stel.bmj.com/content/4/Suppl_1/A10.1. 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/bmjstel-2018-heeconf.15
    • An investigation into suicide amongst ambulance service staff

      Hird, Kelly; Bell, Fiona; Mars, Becky; James, Catheryn; Gunnell, David (2019-01-14)
      Background In 2015, Ambulance Service Medical Directors raised concerns regarding a perceived increase in suicide deaths among ambulance service staff. The Association of Ambulance Chief Executives (AACE) then commissioned a research study to investigate these concerns and provide recommendations towards a suicide prevention strategy. The aim of this study was to determine whether staff who work in the UK ambulance services (AS) are at higher risk of suicide than staff who work in other professions. Methods Data was requested from the Office for National Statistics (ONS) regarding AS staff suicide. Eighteen AS were invited to return data on Occupational Health (OH). AS in England and Wales (n=11) were also asked to return data on staff suicides. Coroners were contacted to request permission to review the records of the deaths. Results The ONS analysis of occupational suicide risk between 2011 and 2015 indicated that there were 20 suicide deaths amongst paramedics in England during that period. The risk of suicide amongst male paramedics was 75% higher than the national average. Over a 2 year period, 8 AS trusts identified 15 staff suicides (11 male, 4 female). The mean age of those dying by suicide was 42 years. Findings from coroners’ records indicated that the predominant suicide method used was hanging (66.7%). Conclusions The following recommendations have been accepted by the AACE: a) Develop a mental health strategy for all staff which includes specific emphasis on suicide prevention b) Review and assess suicide risk at times of increased vulnerability c) Collect and monitor data on AS suicides d) Review occupational health, counselling and support services e) Training for staff in identifying and responding to a colleague in distress f) Return to work discussions should consider and establish the status of an individual’s mental health and wellbeing. https://emj.bmj.com/content/36/1/e3.1. 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/emermed-2019-999.6
    • Improving patient care - the Leeds dedicated palliative care ambulance service

      Borrill, Deborah; Colam-Ainsworth, Will (2014-03)
      Background Leeds have benefited from a bespoke palliative care ambulance service since 2007 when work done with Marie Curie and the “Delivering Choice” programme highlighted the need for the service. Early consultation with stakeholders identified that a lack of appropriate ambulance transport can be one of the factors that restricts or prevents the fulfilment of a patient’s previously expressed wish to die in the place of their choice. Aim The aim of the dedicated palliative care ambulance service is to provide flexible, prompt, safe and comfortable transport to patients moving to a place of their choice towards the end of life and to those needing palliative treatments and investigations. Method The Hospital Specialist Palliative Care Team, Leeds Commissioners, Yorkshire Ambulance Service (YAS) Leeds Hospices and Leeds Community Health worked closely together at a local level to improve the present palliative care ambulance service. Leeds commissioners have now funded a second ambulance to run on weekdays, covering the busiest times and new dedicated crews have been recruited and trained by the local hospice. Results This service will benefit patients, carers, healthcare professionals and healthcare providers by: Helping patients achieve their choice for place of care by reducing delays in discharge caused by restrictions to transport Ensuring appropriately trained ambulance personnel will provide quality care services to patients at the end of life during transportation Providing effective ways of working with professionals Providing better coordination and connectivity between hospital, hospice, community and ambulance services Conclusion In providing patients with choice in place of care at the end of life, whilst improving service provision, it is expected that the number of patients dying at home will increase. Future plans are to monitor present demand with a view to expanding the service further to support the transfer of palliative patients in Leeds. https://search.proquest.com/docview/1783985419/fulltextPDF/EBB9E264BEB34F77PQ/1?accountid=48092. 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/bmjspcare-2014-000654.21
    • 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.
    • Effectiveness of FAST campaign 2009 in South Yorkshire

      Kini, M.; Venables, Graham; Randall, Marc; Ryan, T.; Crossley, J. (2012-12-06)
    • Emergency Medicine Journal COVID-19 monthly top five

      Tonkins, Michael; Miles, Jamie; O'Keeffe, Colin; Jiminez Forero, Sonia; Goodacre, Steve (2021-02-12)
      Following from the successful ‘RCEM weekly top five’ series starting in April 2020, this is the third of a monthly format for EMJ readers. We have undertaken a focused search of the PubMed literature using a standardised COVID-19 search string. Our search between 1 December and 31 December 2020 returned 1183 papers limited to human subjects and English language. We also searched high impact journals for papers of interest. https://emj.bmj.com/content/early/2021/02/11/emermed-2021-211203 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/emermed-2021-211203
    • Can emergency medical service staff predict the disposition of patients they are transporting?

      Clesham, K.; Mason, S.; Gray, J.; Walters, S.; Cooke, V. (2008-10-08)
      Emergency medical service (EMS) staff in the UK routinely transport all emergency responses to the nearest emergency department (ED). Proposed reforms in the ambulance service mean that EMS staff will transport patients not necessarily to the nearest hospital, but to one providing facilities that the patient is judged to require. No previous UK studies have evaluated how accurately EMS staff can predict which transported patients will require admission to hospital. https://emj.bmj.com/content/25/10/691 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.2007.054924
    • AMPDS categories: are they an appropriate method to select cases for extended role ambulance practitioners?

      Gray, J.T.; Walker, A. (2008-09)
      To examine the correlation between the AMPDS prioritisation category at dispatch and the use of alternative clinical dispatch using data from an emergency care practitioner (ECP) service dispatching on likely clinical need. https://emj.bmj.com/content/25/9/601 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.2007.056184
    • Severe hypoglycaemia in the community

      Scott, A.R.; Frampton, E. (2007-10-26)
    • Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial

      Mason, Suzanne; Knowles, Emma; Colwell, Brigitte; Dixon, Simon; Wardrope, Jim; Gorringe, Robert; Snooks, Helen; Perrin, Julie; Nicholl, Jon (2007-11)
      Objective To evaluate the benefits of paramedic practitioners assessing and, when possible, treating older people in the community after minor injury or illness. Paramedic practitioners have been trained with extended skills to assess, treat, and discharge older patients with minor acute conditions in the community. https://www.bmj.com/content/bmj/335/7626/919.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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmj.39343.649097.55
    • Exploring ambulance conveyances to the emergency department: a descriptive analysis of non-urgent transports

      Miles, Jamie; O'Keeffe, Colin; Jacques, Richard; Stone, Tony; Mason, Suzanne (2017-12)
      An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response. https://emj.bmj.com/content/34/12/A872. 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/emermed-2017-207308.17