Now showing items 1-20 of 1757

    • Experiences of homeless individuals using ambulance services: a narrative review

      Hichisson, Andrew (2024-07-02)
      Background: Homeless individuals are vulnerable and have a higher burden of illness. Barriers to care exist and experiences can be negative, contributing to increased morbidity and mortality. The experiences of homeless individuals accessing healthcare through ambulance services is underexplored. Aims: The study aims to describe why homeless individuals access healthcare through ambulance services and identify lived experiences. Methods: A narrative literature review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology, with Critical Appraisal Skills Programme tools used to assess quality before thematic synthesis. Results: Twenty three studies were included. Six themes were identified including frequency of ambulance use and clinical characteristics, why healthcare is accessed through ambulance services and the experiences of homeless individuals and paramedics. Conclusions: Evidence relating to homeless individuals accessing healthcare through ambulance services is limited. However, it is clear this group uses these services more often than non homeless individuals, likely because of their higher chronic illness burden. Services should be developed to meet the needs of homeless individuals and to help ensure demand on ambulance services is manageable and affordable. Abstract published with permission.
    • Deprivation links to bystander cardiopulmonary resuscitation and defibrillation rates

      Keeping, Chloe Kate; Whitley, Gregory (2024-08-02)
      Background: Public access defibrillators and cardiopulmonary resuscitation (CPR) have been at the forefront of public health campaigns and public education and are key links in the chain of survival. Despite this, survival rates for out-of-hospital cardiac arrest (OHCA) in 2024 in the UK are lower than in comparable countries. Aims: This study aimed to critically review research in the UK to identify whether a patient’s level of socioeconomic deprivation impacts their chances of receiving bystander CPR and defibrillation. Methods: A rapid evidence review was conducted with literature searches from 2013 to July 2023 carried out. Five studies were identified. Findings: OHCA incidence was lowest in areas of least deprivation, while the most deprived populations had lower rates of bystander CPR (BCPR) with higher OHCA incidences. Automated external defibrillator (AED) provision did not correlate with OHCA incidence. Conclusion: Research is needed to look at areas with a high incidence of OHCA associated with low rates of BCPR, with the aim to target high-risk areas of low BCPR and high OHCA incidences for public education and AED installation, including qualitative research into the population’s thoughts and knowledge of CPR and defibrillation. Abstract published with permission.
    • Influence of simulation fidelity on student learning in a prehospital setting

      Graham, Sean; Sealey, Amy (2024-07-02)
      Background: Simulation creates a low-risk environment for patients and participants and allows experiential learning. Aims: This literature review aims to determine whether the fidelity of simulation (the extent to which it reflects reality) influences learning. Methods: A search of databases for research within the past 10 years was carried out, and 22 articles were reviewed. Findings: Three themes emerged: models of simulation that address fidelity; the role of the facilitator; and need for sound educational theory to underpin simulation. Conclusion: Although evidence is sparse, simulation offers benefits to paramedic students and paramedics. It is particularly useful regarding rarely occurring events, especially those with significant consequences. While a high-fidelity prehospital scenario can be difficult to achieve, simulation can be educationally effective. Effectiveness depends on: the simulation model; whether fidelity is appropriate to the scenario and recognises participants’ sensory capacity; having a dedicated facilitator; and being based on a sound educational strategy. This combination allows learning outcomes to be met and the gap between theory and practice to be bridged. Abstract published with permission.
    • Time for reflection

      Cochrane, Alice (2024-08-02)
      In April, I began my career with Northern Ireland Ambulance Service (NIAS) alongside five other newly qualified paramedics (NQPs), who each are at varying stages of their NQP programme—I am right at the start of mine. The NQP framework is relatively new to Northern Ireland, mainly driven by the recent establishment of an undergraduate paramedic degree at Ulster University. It is fair to say that I felt like a guinea pig and I was worried about how this ‘trial and error’ would affect my progression as an NQP. Abstract published with permission.
    • Practice-based education: a scoping review

      Godley, Nicola; Devlin, Lauren; Watson, Jay; Davidson, Tom (2024-08-02)
      Background: Apprenticeships are key to ensuring that private and public employers can recruit and develop workforces. The degree apprenticeship in paramedic practice allows learners to continue academic study while participating in on-the-job training. Objectives: The aim of this UK-based scoping review is to identify the barriers and challenges in practice-based education, and link the findings to paramedic degree apprenticeships. Methods: A scoping review was undertaken to examine the literature on degree apprenticeships and the barriers and challenges within practice-based education. Findings: Six studies were reviewed. None were specific to paramedicine, so analysis and evaluation were drawn from other professions. Three main themes were identified: role of the mentor/practice-based educator; stakeholder collaboration; and apprentice support. conclusion: Employers are key to the collaborative design of apprenticeship, yet multiple issues in terms of their working with higher education institutions exist. The interpretation of apprenticeship-specific terminology used to assess competence, and the subjective definition of expected standards were key concerns of practice educators. Employers need to provide education to practice educators to support the facilitation of learning and assessment. Responsibility for the success of apprentices lies with both employer and learner. More research is needed on barriers for each stakeholder. Employers require clearer guidance regarding funding and expectations. Abstract published with permission.
    • Paramedics at risk? How responding to a terror attack affects mental wellbeing

      Tew, Joanna; Ward, Richard (2024-10-02)
      Background: Terror attacks have a significant impact on first responders’ wellbeing, with an associated risk of post-traumatic stress disorder (PTSD). Aims: To improve understanding of how responding to terror attacks affects paramedics’ mental health. Methodology: A literature search was carried out on databases using the PRISMA strategy. Critical appraisal tools were used alongside thematic analysis to appraise and synthesise the literature. Findings: Ten papers were identified. Themes arising regarding risks to responders included: the level of exposure, with the amount related to the risks of developing PTSD and psychopathology; and level of preparedness, with responders carrying out unfamiliar tasks and working outside the scope of practice as well as lacking education on the psychological impact of terror attacks. Conclusion: If paramedics are deployed into terror attack warm zones, policy needs to consider the associated psychological risk. Training should incorporate stress management techniques and education on the extreme emotions these practitioners may experience. More research specifically with the paramedic population is required to understand the risk posed to them and how this may be managed. Abstract published with permission.
    • Both sides of the picture

      Cochrane, Alice (2024-10-02)
      In the June issue, I shared with you the first few weeks of being a Newly Qualified Paramedic (NQP); discussing the induction process and my first shifts ‘out on the road’. Up to now, I have been working with paramedics of varying experience, and have had a few shifts with emergency medical technicians (EMTs). I have settled well into my station and am fortunate to be able to attend a variety of ‘jobs’; I could be in the city centre of Belfast or down towards Portaferry – the joys of working in a small country! Abstract published with permission.
    • 999 EMS Research Forum Conference 2024 programme

      999 EMS Research Conference (2024-09-23)
    • Annual SHOT Report 2023

      Serious Hazards of Transfusion (SHOT) (2024-07)
    • Incidental findings of atrial fibrillation by ambulance clinicians: variation in management across the UK

      Blair, Laura; McClelland, Graham; Shaw, L.; Price, C; Wilkinson, C (2024)
    • To err is an opportunity

      Sofield, Katy (2024-09-02)
      Overall, this summer has been a good one. I re-started scuba diving. Now that I have a steady income, I can take up an old hobby. I have rekindled my love for the water and being under water – though, at 17˚C, the UK waters are a tad colder than the lovely 28˚C waters of the Dominican Republic I visited in March. July also saw graduation. Despite finishing university in September 2023, graduation was held in July 2024. It was lovely to spend a week back in the North of England, seeing old mentors and friends. During graduation, I had the opportunity to speak with my tutors that had moved on to different pastures. It was lovely to see them and tell them about my adventures in London.However, the week before graduation, while on a day shift, I made my first major error. I attended to a patient who was fitting. In the London Ambulance Service (LAS), we administer Midazolam to assist in terminating seizure activity. Abstract published with permission.
    • The views of current and future paramedics on prescribing: a review

      Harrison, Charles Nicholas (2024-09-02)
      Following a change in legislation in 2018, paramedics gained prescribing rights but, as this is a recent change, no reviews have been carried out into their experiences. Aim: The overarching aim of this article is to understand the thoughts and opinions of current and future paramedic prescribers on non-medical independent prescribing. It also aims to identify potential barriers to paramedic independent prescribing (PIP), investigating the gaps within medication options, and the role of PIP in the autonomous scope of paramedic practice. Methods: A literature search of MEDLINE, CINAHL, PubMed and CENTRAL was undertaken in January 2023, with articles also gathered from grey literature, Google Scholar, citation searching and author contacting to identify literature for review. Six articles underwent thematic analysis, and four themes were identified: advanced practice; improved medication management; barriers to implementation; and effect on current practice. Findings: Overall, there are significant positives to paramedic independent prescribing, such as improved patient experiences, more medication options and fewer hospital admissions. However, there were concerns, which centred on the implementation process, underpinning support and increased responsibility. Abstract published with permission.
    • ECGs on the go: a clinical comfort blanket

      Romano, Vincent (2024-09-02)
      While not a book, another valuable resource for paramedics from Class Professional Publishing will be the subject of this quarter’s Book Review. Within this pack, you will find 21 colour-coordinated cards. The colours separate the cards into five different categories related to electrocardiogram (ECG) interpretation: l ST-Segment change Bundle Branch Blocks AV Blocks SVT rhythms Ventricular rhythms. All the topics covered are ones you would expect to find on a paramedic degree course and that have relevance in the prehospital setting. Abstract published with permission.
    • Maternity emergencies 2: normal birth

      Yarrington, Aimee (2024-09-02)
      Birth is a physiological process. However, when occurring unplanned prehospitally, it is a clinically significant event that is often unexpected and can be the cause of great anxiety. This is generally due to paramedics’ lack of exposure and training in maternity in general, the fear of the unknown and the concerns about ‘what if something goes wrong?’ An understanding of the physiology and how birth processes work will assist with the decisions around transporting the woman in labour and how to manage a birth if it occurs rapidly and unexpectedly. This series on maternity care will highlight a range of maternity emergencies and detail the pathophysiology as well as their prehospital treatment and management. Abstract published with permission.
    • When 999 gets called at the end of life: equipping ambulance clinicians to promote a dignified death (hospices and ambulance service working together)

      Nicell, Claire; Smith, Richard; Hill, James; Stead, Sarah (BMJ, 2017-11-01)
      Background End of life care is an emergent aspect of ambulance clinicians’ work. They are often called to an emergency or crisis in an individual’s last days of life and have to make complex decisions with limited information. However they receive limited formal palliative care education. Two hospices were approached by a local paramedic to see if they could help address this educational need. Aim of the Collaborative Work For ambulance clinicians to gain confidence in recognising end of life needs of patients and their families and delivering appropriate care. For hospice professionals to understand the role and abilities of ambulance clinicians in delivering end of life care. What have we achieved? Two hospices and their local Ambulance NHS Trust worked collaboratively to devise a one-day workshop for paramedics to explore palliative and end of life care. The workshop included communication skills, symptom control, recognising dying, promoting patient wishes and accessing local palliative care services. Feedback from 70+clinicians was good and their confidence scores increased ‘Helps make a grey area of our work more understood.’ Two paramedics completed the European Certificate in Essential Palliative Care and are recognised locally as palliative care champions within their work in the community and control room. Links established with local university; end of life care sessions delivered to third-year paramedic students and palliative care student placements arranged. Additional Benefits Increased mutual understanding of practitioners’ roles – informing practice and education. Paramedics accessing ongoing communication skills training. Paramedics delivering teaching to hospice staff highlighting end of life care challenges. Improved communication between ambulance crews and local hospices. Joint hospice and ambulance end of life care Facebook discussion delivered as part of the Ambulance’s service End of Life Care Awareness month Joint end of life care strategy working. https://spcare.bmj.com/content/bmjspcare/7/Suppl_2/A8.1.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/openhrt-2015-000281
    • Mixed methods study exploring factors influencing ambulance clinician decisions to pre-alert emergency departments (EDS) of a patient’s arrival

      Sampson, Fiona; Pilbery, Richard; Herbert, Esther; Long, Jaqui; Coster, Joanne; O'Hara, Rachel; Bell, Fiona; Goodacre, Steve; Rosser, Andy; Spaight, Robert; et al. (2023-11-28)
      Aims and Objectives Ambulance pre-alert calls can lead to improved treatment of time-critical patients by enabling Emergency Departments (EDs) to prepare for their arrival but need to be used judiciously to optimise patient care. Despite their importance, there is a lack of research understanding how pre-alert decisions are made. We aimed to understand factors influencing ambulance clinician pre-alert decision-making. Method and Design Using a convergent parallel mixed-methods design we integrated quantitative and qualitative data from three Ambulance Services and six Emergency Departments using: 1) linked routine dataset of 12 months’ (2020/21) electronic patient records (3 Ambulance Services), clinician information and routine hospital statistics 2) semi-structured interviews with 35 ambulance clinicians and 40 ED staff and 156 hours non-participation observation of pre-alerts across six EDs. Lasso regression to identify candidate variables for multivariate logistic regression was undertaken in R(™) to explain variation in pre-alert rates in terms of patient (NEWS2 score, working diagnosis, age, sex), ambulance clinician (experience, role, sex, time to end of shift) and hospital factors (journey time,% ambulances waiting >30 mins). Qualitative data was analysed using thematic analysis in NVivo(™). Findings were integrated using a triangulation protocol. Results and Conclusion Variation in pre-alert practice was not fully explained by casemix. Overall 142,795/1,363,274 conveyances were pre-alerted. Highest overall odds ratios (ORs) for pre-alert were associated with patient factors (working diagnosis OR:4.16,CI:4.05-4.26, NEWS2 OR:1.4,CI:1.39-1.4) but thresholds for pre-alerting varied between ambulance clinicians. Pre-alerts were more likely when there were longer turnaround times at EDs (OR:1.83,CI:1.69-1.98), potentially due to ambulance clinicians’ concerns about their ability to effectively manage deteriorating patients where long handovers were anticipated. There was a significant difference in pre-alert rates between EDs (figure 1) that was not explained by type of hospital (e.g. Major Trauma Centres). Anticipated ED response to pre-alerts had a significant impact on pre-alert decisions due to variation in ED protocols and expectations. https://emj.bmj.com/content/40/12/875 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/
    • 'Knowledge exchange’ workshops to optimise development of a risk prediction tool to assist conveyance decisions for suspected seizures – part of the Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project

      Noble, Adam J.; Morris, Beth; Bonnett, Laura J.; Reuber, Markus; Mason, Suzanne; Wright, Jasmine; Pilbery, Richard; Bell, Fiona; Shillito, Tom; Marson, Anthony G.; et al. (2024-01-09)
    • CPR Quality Officer role to improve CPR quality: a multi-centred international simulation randomised control trial

      Sumera, Kacper; Ilczak, Tomas; Bakkerud, Morten; Lane, Jon Dearnley; Pallas, Jeremy; Martorell, Sandra Ortega; Sumera, Agnieszka; Webster, Carl A.; Quinn, Tom; Sandars, John; et al. (2024-01-02)