Now showing items 1-20 of 1251

    • Celebrating International Women's Day: where does this leave the paramedic profession?

      Wilson, Caitlin; Prothero, Larissa Stella; Williams, Julia (The College of Paramedics, 2022-03)
    • An atypical presentation of orthostatic hypotension and falls in an older adult

      Thoburn, Steve; Cremin, Steve; Holland, Mark (The College of Paramedics, 2022-03)
      Introduction: Falls are a significant cause of morbidity and mortality in older adults. Orthostatic hypotension (OH) is very common in this cohort of patients and is a significant risk for falls and associated injuries. We present the case of an 89-year-old female who fell at home, witnessed by her husband. OH was identified during the clinical assessment and considered to be the predominant contributing factor, although the clinical presentation was not associated with classical symptoms. Case presentation: The patient lost balance while turning away from the kitchen sink; she noted some instability due to a complaint of generalised weakness in both of her legs. No acute medical illness or traumatic injury was identified. A comprehensive history was obtained that identified multiple intrinsic and extrinsic risk factors for falling. The cardiovascular examination was unremarkable except for OH, with a pronounced reduction in systolic blood pressure of 34 mmHg at the three-minute interval and which reproduced some generalised weaknesses in the patient's legs and slight instability. Although classical OH symptoms were not identified, this was considered to be the predominant factor contributing to the fall. A series of recommendations was made to primary and community-based care teams based upon a rapid holistic review; this included a recommendation to review the patient's dual antihypertensive therapy. Conclusion: It is widely known that OH is a significant risk factor for falls, but asymptomatic or atypical presentations can make diagnosis challenging. Using the correct technique to measure a lying and standing blood pressure, as defined by the Royal College of Physicians, is crucial for accurate diagnosis and subsequent management. Ambulance clinicians are ideally placed to undertake this quick and non-invasive assessment to identify OH in patients that have fallen. Abstract published with permission.
    • A survey of ambulance clinicians’ perceptions of recording and communicating patient information electronically

      Barrett, Jack; Eaton-Williams, Peter; Mortimer, Craig; Land, Victoria; Williams, Julia (2021-06-01)
      Objective: Ambulance services are evolving from use of paper-based recording of patient information to electronic platforms and the impact of this change has yet to be fully explored. The aim of this study is to explore how the introduction of a system permitting electronic information capture and its subsequent sharing were perceived by the ambulance clinicians using it. Methods: An online questionnaire was designed based upon the technology acceptance model and distributed throughout one ambulance service in the south east of England. Closed-ended questions with Likert scales were used to collect data from patient-facing staff who use an online community falls and diabetic referral platform or an electronic messaging system to update GPs following a patient encounter. Results: There were 273 responses from ambulance clinicians. Most participants agreed that they used tablet computers and smartphones to make their life easier (85% and 86%, respectively). Most participants felt that referring patients to a community falls or diabetic team electronically was an efficient use of their time (81% and 81%, respectively) and many believed that these systems improved the communication of confidential patient information. GP summaries were perceived as increasing time spent on scene but most participants (89%) believed they enabled collaborative working. Overall, collecting and sharing patient information electronically was perceived by most participants as beneficial to their practice. Conclusion: In this study, the ability to electronically refer patients to community services and share patient encounters with the GP was predominantly perceived as both safe for patients and an effective use of the participants’ clinical time. However, there is often still a need to communicate to GPs in real time, demonstrating that technology could complement, rather than replace, how clinicians communicate. Abstract published with permission.
    • In a simulated adult trauma patient, can pelvic binders be applied accurately by paramedics and HEMS paramedics? A pilot observational study

      McCreesh, Samuel (2021-05-01)
      Pre-hospital treatment of suspected haemorrhagic pelvic fractures includes application of a purpose-made pelvic binder. Recent hospital studies identified poor accuracy of pelvic binder application, but there is little pre-hospital research to date. Abstract published with permission.
    • To collar or not to collar. Views of pre-hospital emergency care providers on immobilisation without cervical collars: a focus group study

      Thompson, Lee; Shaw, Gary; Bates, Charlotte; Hawkins, Christopher; McClelland, Graham; McMeekin, Peter (2021-05-01)
      Spinal cord injury (SCI) is a rare event, with high numbers of patients unnecessarily immobilised with no potential benefit based on limited evidence from the 1950s and 1960s. Contemporary opinion now challenges the notion that traditional immobilisation prevents movement and protects the spine. Current literature suggests that these methods which include semi-rigid collars can potentially cause more movement of the spine and harm the patient. The purpose of this study was to explore the views and perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar. https://www.ingentaconnect.com/content/tcop/bpj/2021/00000006/00000001/art00006 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/10.29045/14784726.2021.6.6.1.38 Abstract published with permission.
    • Paramedic independent prescribing: a qualitative study of early adopters in the UK

      Stenner, Karen; Van Even, Suzanne; Collen, Andy (2021-05-01)
      Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care. Abstract published with permission.
    • A paramedic's role in reducing number of falls and fall-related emergency service use by over 65s: a systematic review

      Bonner, Mhairi; Capsey, Matt; Batey, Jo (2021-05-01)
      Background: Around 10–25% of emergency calls for adults aged over 65 are attributed to falls. Regardless of whether injuries are caused, quality of life is often affected by fear of falling, leading to reduced confidence and activity, negatively impacting mobility and risking depression and isolation. Ambulance service staff are well placed to identify falls risk factors so patients can be directed to falls prevention services. This article aims to determine how the referral by paramedics of uninjured falls patients to community falls services may reduce future falls and emergency services use. http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=93c754e6-fdac-46d2-9a69-95fb0f3e91e0%40sdc-v-sessmgr03 http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.29045/14784726.2021.6.6.1.46 Abstract published with permission
    • How to implement live video recording in the clinical environment: A practical guide for clinical services

      Lloyd, Adam; Dewar, Alistair; Edgar, Simon; Caesar, Dave; Gowens, Paul; Clegg, Gareth (2017-06)
    • Validation of the National Early Warning Score in the prehospital setting

      Silcock, Daniel; Corfield, Alasdair; Gowens, Paul; Rooney, Kevin (2015-04)
    • Optimizing trauma system design: The GEOS (Geospatial Evaluation of Systems of Trauma Care) approach

      Jansen, Jan; Morrison, Jonathan; Wang, Handing; Lawrenson, Robin; Egan, Gerry; He, Shan; Campbell, Marion (2014-04)
    • Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study

      Wang, Huan; Donnan, Peter; Leese, Callum; Duncan, Edward; Fitzpatrick, David; Frier, Brian; Leese, Graham (2017-08-15)
    • Prehospital improvisation of standard oxygen therapy equipment to facilitate delivery of a bronchodilator in a supine patient

      Fitzpatrick, David; Brady, James; Maguire, Donogh (2012-11)
      A police request was made to the ambulance service to attend an adult victim of an alleged assault. On arrival the patient was found to be alert (AVPU: alert, responds to verbal stimuli, responds to pain, unresponsive), in a seated position, and complaining of head, neck and back pain. The airway was clear; a mild diffuse polyphonic wheeze was noted bilaterally throughout both lungs. Respiratory rate was 16 bpm and heart rate was 126 bpm. Oxygen therapy was commenced via a duo mask (fractional inspired oxygen (FiO2) 0.53) as oxygen saturation was recorded initially at 94% on air. The mechanism of injury caused concern regarding possible c-spine injury as the patient's head had been struck forcefully against the wall. The patient denied any loss of consciousness. Bony tenderness was elicited during c-spine examination and a c-spine collar was applied with full spinal precautions. The patient was immobilised using a long board, head huggers and straps to facilitate removal to the ambulance. Acute alcohol intoxication enabled only a vague medical history but inferred alcohol misuse and smoking. https://emj.bmj.com/content/29/11/921. 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.2011.111666
    • Socioeconomically equitable public defibrillator placement using mathematical optimization

      Leung, K. H. Benjamin; Brooks, Steven C.; Clegg, Gareth; Chan, Timothy C. Y. (2021-09)
    • The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A Prospective Cohort Study

      Cooper, Jamie; Ferguson, James; Donaldson, Lorna A.; Black, Kim M. M.; Livock, Kate J.; Horrill, Judith L.; Davidson, Elaine M.; Scott, Neil W.; Lee, Amanda J.; Fujisawa, Takeshi; et al. (2021-06)
    • ‘We wear too many caps’: role conflict among ambulance service managers

      Miller, Joshua (2019-03-01)
      Aims: A qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work, including how they see their role in this task. As research on managers in this field is largely limited to settings outside the NHS, the study was planned as exploratory in nature and developed themes arising from the data. Methods: Face-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The interview guide included specific questioning on role and identity. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained. Results: The participants were all clinically-trained managers with responsibility for first-line management of front line ambulance crews. They discussed their varying roles both implicitly and explicitly. The roles included: manager, clinician, peer, referrer, ‘adjudicator’, parent figure, ‘the appropriate person’ and the challenger. They discussed the tensions of managing performance and providing emotional support to the same staff, including how some managers perceived this as making staff reluctant to disclose distress. Several participants acknowledged that they were actively creating narratives from different role perspectives, and that readers of the study would also judge them against these different roles. Conclusion: This study suggests that ambulance service managers within an NHS trust may feel conflicted between varying roles, some relating to their professional identities, and some to work tasks such as performance management and staff support, which may be in tension. Some respondents felt this could make potentially traumatised staff reluctant to disclose distress, which has negative implications in a sector where stress and psychological illness is ascribed as contributing to around 15% of staff sickness. Further research could be conducted into whether this possible role conflict is seen by front line staff as a barrier to disclosing distress. Abstract published with permission.
    • ‘The ones that don’t say’; challenges in managers identifying potentially traumatised ambulance staff

      Miller, Joshua (2019-01-14)
      Background Stress and psychological illness among emergency services personnel is reported at higher prevalence than the general population, with one UK ambulance service ascribing it to 15% of staff sickness. Research in this field has focused on ambulance crew views, while manager experiences are limited to EMS systems outside the UK. This qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work. Methods Face-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained. Results All participants claimed to see the identification of potentially traumatised staff as a vital part of their role. They outlined the use of case factors such as visceral elements and child involvement, and staff factors such as home life and resilience. Interviewees talked about their changing roles as managers, peers, parent figures, clinicians, and adjudicators. Factors found as enabling the identification of potentially traumatised staff included: knowing the staff, formalising handover to other managers, and manager presence – both at incidents and on station. Disabling factors included: atypical cases, hierarchical culture, and isolated remote staff. All participants reported concerns about staff being reluctant to report distress. Conclusions Limitations of this study include the small sample size, possible response bias, and respondents conforming to social norms, as their practice was self-reported, rather than observed. Manager presence was highlighted as very important by participants; services should consider this in their structures and policies. Further studies could examine staff reluctance to report psychological distress, as well as staff resilience, which participants saw as beneficial, yet difficult to define or predict. https://emj.bmj.com/content/36/1/e4.3. 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-2019-999.10
    • Better together? Ambulance staff views of human factors in resuscitation

      Miller, Joshua (2015-05-19)
      Background Research into the care of cardiac arrest patients outside of hospital is limited. Evidence from hospital settings suggests that human factors including both technical and non-technical skills and performance may impact on care. This study sought staff views from a UK ambulance service aiming to investigate areas for improvement in resuscitation performance. Methods Volunteer ambulance staff responded to an open invitation to complete an anonymous internet-based survey. The survey used a mixture of closed questions, Likert-scaled answers and free text to explore staff views on resuscitation performance. Quantitative responses were presented graphically, and free text answers arranged by theme. Results 111 staff responded to the survey. The results demonstrated that staff see effective teamwork as desirable in out-of-hospital resuscitation, but that this is not always the case currently. Staff felt more confident about practical skills such as cannulation and chest compression delivery. Difficulties were noted in: poor communication between staff members; inconsistent identification and nomination of leaders; low staff confidence in peri- and post-cardiac arrest conversations with relatives; and insufficient staff numbers on scene. Conclusions The findings demonstrate poor staff confidence in several non-technical skills, including teamwork and communication. Limitations of the survey included lack of recording of training received—where this has shifted in recent years from in-service to higher education routes—and missing demographic data. However, the findings provide specific areas for improvement activity. This has already included best practice slides displayed in ambulance stations, and proposals for identification wristbands, a role-based work standard to reduce task omission and duplication, and a policy to send higher numbers of rescuers to cardiac arrest cases. https://emj.bmj.com/content/32/6/e14.2. 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/emermed-2015-204980.8