Now showing items 1-20 of 1288

    • A qualitative analysis of stressors affecting 999 ambulance call handlers’ mental health and well-being

      Powell, Catherine; Fylan, Beth; Lord, Kathryn; Bell, Fiona; Breen, Liz (2022-09-28)
    • One patient at a time

      Costello, Barry (2022-11-02)
      When I was a student paramedic, my mentor had a steady string of little pearls of wisdom like this, always hidden behind a wall of dark humour and cynicism, but that were equally endearing towards my untainted, and unhinged enthusiasm for all things paramedic. And while I did not fully know what he meant at the time, after 3 years as a student, and now 2 as an NQP, I am finally starting to understand it. Abstract published with permission.
    • Advancing practice through the lens of patient care

      Eaton, Georgette (2022-11)
      Just over a decade ago, when I first registered with the Health and Care Professions Council (HCPC) (then the Health Professions Council), I did not picture a career outside of the back of an ambulance—unless I ceased to be a paramedic entirely. Yet, over the last 10 years, one of the main components that has catalysed the development of the profession is the idea that paramedics could capitalise their generalist unique selling point (USP) to work to an enhanced clinical level. The development of the paramedic profession itself is not new—we have continuously developed since our inception from working clinically within the constraints of providing life support under the supervision of cardiologists, to being autonomous clinicians in our own right. However, the progression to working within advanced practice has been something new—and I think we have the changing model of care delivery within the ambulance service to thank for this. Abstract published with permission.
    • A mass distribution letter as an early intervention for potential frequent callers

      McDonnell, Aidan Joseph; McLaughlin, Russell; O'Neill, Ronan; Wolfe, Julia; Sinclair, Neil; Ruddell, Nigel (2022-11-02)
      Intensive engagement with frequent callers (FCs) has been shown to be effective at reducing call volumes and producing positive outcomes for service users. Aims: This study aimed to examine the impact of sending a mass distribution letter to potential frequent callers (PFCs) on emergency call volumes. Methods: A standardised letter containing advice and information for newly identified PFCs was introduced in an attempt to signpost service users to more appropriate care providers before they met the FC criteria. In total, 96 letters were distributed to PFCs and their impact on emergency call volumes was assessed. Findings: Emergency calls decreased from 439 to 187 in the 10 weeks following letter distribution, equating to an average reduction of 57.5%. Conclusion: An association was found between letter distribution and a reduction in emergency calls. Future opportunities for development include an emphasis on feedback from recipients and determination of specific causality. Abstract published with permission.
    • Where to look: sources of research in paramedicine

      Holland, Matt; Dutton, Michelle; Glover, Steve (2021-08)
      This article explains how to approach searching for paramedicine research, and the order in which you should consider types of sources, from synthesised sources to individual studies. Databases and sources for literature are covered and common issues about the search process are addressed, including when a search is complete and finding a gap in the literature. 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. DOI
    • Prehospital triage tools in major trauma: a critical appraisal of a systematic review

      Bell, Steve; Hill, James E (2022-09-02)
      Effective triage is critical to ensure patients suffering major trauma are identified and access a pathway to definitive major trauma care, which is typically provided in a major trauma centre as part of an established major trauma system. The prehospital triage of trauma patients often relies upon the use of major trauma triage tools; this commentary critically appraises a recent systematic review that sought to evaluate and compare the accuracy of prehospital triage tools for major trauma. Abstract published with permission.
    • Use of specialist paramedic dispatch in emergency ambulance control

      Fell, Simon; Corrie, Ian (2022-04-07)
      Optimising patient care through the delivery of specialist resource allocation at the point of injury improves patient outcomes. As identified by the NHS, high-quality call handling and dispatch of the right response, first time, is critical to these outcomes (NHS, 2015). Aim: This article presents an objective literature review and critical analysis of the evidence base concerning clinical dispatch. This study aims to highlight key differences between the triage and dispatch processes of specialist resources, to establish if the evidence supports the use of one model to manage these resources, and to ascertain best practice. Method: A structured literature review was undertaken and thematic analysis was used to explore the findings of the literature, leading to the establishment of recommendations for best practice in this area. Results: The literature discourages dispatching specialist teams based solely on computeraided dispatch software codes, and recognises that specialist paramedic dispatchers have a better understanding of the clinical and ethical challenges of appropriately dispatching specialist, finite resources. Conclusion: The literature supports the use of clinicians in dispatching specialist resources to best meet the needs of those patients who are critically ill or injured. Abstract published with permission.
    • The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitioners

      Muldoon, Damian; Seenan, Chris (2021-12)
      Primary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs' experiences are of these developments. Abstract published with permission.
    • A retrospective cross-sectional analysis of re-contact rates and clinical characteristics in diabetic patients referred by paramedics to a community diabetes service following a hypoglycaemic episode

      BLOOMER, KARL (2021-09)
      A retrospective cross-sectional study of routinely collected data by the Northern Ireland Ambulance Service HSC Trust of individuals referred to a community diabetic service following ambulance attendance and non-conveyance. Data were collected over a 3-month period with ambulance service re-contact and clinical data analysed. Abstract published with permission.
    • Re-contact demographics and clinical characteristics of diabetic patients treated for a hypoglycaemic episode in the pre-hospital environment: a rapid literature review

      BLOOMER, KARL (2019-09)
      Diabetes mellitus has been referred to as an 'epidemic' and the World Health Organization reported 422 million people with the disease in 2014. Hypoglycaemia is common among emergency presentations, yet understanding around the utilisation of emergency medical services (EMS) for this is incomplete.Ambulance service referral pathways for those suitable to be treated in the community have been developed as a means of managing this growing demand. However, there is limited evidence to suggest how they should be constructed or implemented.The aim of this review was to examine patients who re-contacted the health services following EMS non-transport for a hypoglycaemic episode and to determine if risk factors could be identified. Abstract published with permission.
    • The good fight: lessons from the pandemic

      Costello, Barry (2022-09-02)
      I love the job, I just hate the politics. After 2 years of feeling like I am on a sinking ship constantly trying to plug holes while taking on water—call to call, patient to patient—it is easy to see why so many become disheartened, why so many look to other avenues outside the daily grind of the ambulance service, or why some leave the profession entirely. This narrative is nothing new, the ambulance service, and indeed the NHS has faced relentless pressures for a number of years now—but as we finally emerge from the COVID-19 pandemic, it is clear that something is different. As a newly qualified paramedic (NQP), I am starting to see this manifest in longer waits outside hospital, delayed response times to our sickest patients, and even some patients dying in the back of ambulances while they wait countless hours to be triaged. For the first time in my career as a paramedic, I cannot help but feel that, despite my best efforts, I am failing my patients. Abstract published with permission.
    • Mental health care in paramedic practice

      Romano, Vincent (2022-09-02)
      If you are a frontline clinician within an ambulance service, you will be fully aware that mental health incidents are commonplace, complex, time consuming and, at times, frustrating for both patient and clinician. The traditional training that paramedics and technicians undergo will include mental health conditions; however, the proportion of incidents attended compared to the time afforded to this topic do not equate. I can confidently say that a Paramedic BSc programme will spend considerably more time covering trauma management and cardiac arrest than how to take a comprehensive mental health history, formulate a safe plan and accept a refusal from a patient that has self-harmed and will not go to hospital. Abstract published with permission
    • Paramedic pharmacology: more than facts and dosages

      Wilson, Caitlin (2022-08-02)
      As someone who recalls agonisingly learning JRCALC drug dosages, cautions and (contra-) indications off by heart during my undergraduate paramedic degree, I was not particularly looking forward to the idea of reviewing a pharmacology book. However, the introductory paragraphs of Pharmacology for Paramedics seemed like they were written for someone just like me and put my worries at ease. The authors start off with a detailed case study and draw the reader in to actively consider the appropriate clinical decisions and treatment plan by asking poignant questions. However, they then ask the reader not to approach pharmacology as a topic that requires memorisation of a multitude of facts and dosages— but rather to view it as an opportunity to synthesise and apply all prior learning on anatomy and physiology, as well as disease management. They ask the reader to stop and reflect upon how they would apply what they are reading in a patient encounter. Now that sounds far more interesting and relevant than learning things off by heart! Compliments to the authors for getting me to open my mind to this topic—if nothing else, I have a slightly more positive view of pharmacology. Abstract published with permission.
    • Impact of a dedicated trauma desk in ambulance control on the identification of major trauma in Scotland

      Bruce, J.; Parker, A.; Donald, M.; Esposito, M.; Curatolo, L.; Kennedy, A.; Simpson, K.; Morton, C.; Cormack, J.; Austin, M. (2014-03-17)
    • Mental health emergencies and COVID-19: the impact of 'lockdown' in the East Midlands of the UK

      Moore, Harriet Elizabeth; Siriwardena, Aloysius Niroshan; Gussy, Mark; Tanser, Frank; Hill, Bartholomew; Spaight, Robert (2021-07)
    • Data linkage to reduce severe hypoglycaemia

      Cunningham, S.G.; Urquhart, W.M.; Taylor, A.; Jamieson, F.; Robertson, S.; Neilan, L.; Gillies, N.; Brown, K.; MacDonald, N.; Chalmers, J. (2020-09)
    • Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study

      Marincowitz, Carl; Stone, Tony; Hasan, Madina; Campbell, Richard; Bath, Peter A.; Turner, Janette; Pilbery, Richard; Thomas, Benjamin David; Sutton, Laura; Bell, Fiona; et al. (2022-05)
      Objective - To assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy. Design - Observational cohort study. Setting - Emergency telephone triage provided by Yorkshire Ambulance Service (YAS) National Health Service (NHS) Trust. Participants - 12 653 adults who contacted EMS telephone triage services provided by YAS between 2 April 2020 and 29 June 2020 assessed by COVID-19 telephone triage pathways were included. Outcome - Accuracy of call handler decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from first contact with the telephone triage service. Results - Callers contacting EMS dispatch services had an 11.1% (1405/12 653) risk of death or needing organ support. In total, 2000/12 653 (16%) of callers did not receive an emergency response and they had a 70/2000 (3.5%) risk of death or organ support. Ambulances were dispatched to 4230 callers (33.4%) who were not conveyed to hospital and did not deteriorate. Multivariable modelling found variables of older age (1 year increase, OR: 1.05, 95% CI: 1.04 to 1.05) and presence of pre existing respiratory disease (OR: 1.35, 95% CI: 1.13 to 1.60) to be predictors of false positive triage. Conclusion - Telephone triage can reduce ambulance responses but, with low specificity. A small but significant proportion of patients who do not receive an initial emergency response deteriorated. Research to improve accuracy of EMS telephone triage is needed and, due to limitations of routinely collected data, this is likely to require prospective data collection. 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.
    • Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial

      Crombie, Nicholas; Doughty, Heidi; Bishop, Jonathan R.B.; Desai, Amisha; Dixon, Emily F.; Hancox, James M.; Herbert, Mike J.; Leech, Caroline; Lewis, Simon J; Nash, Mark R; et al. (2022-04)
    • What Not to Do with PPE: A Digital Application to Raise Awareness of Proper PPE Protocol

      Gibbons, Eve; Poyade, Matthieu; Rea, Paul; Fitzpatrick, David (2021-09-03)