Research

Health behaviours in ambulance workers

Introduction: Awareness is increasing that health behaviours, which are a part of a person's lifestyle, have significant effects on emotional and physical wellbeing. Ambulance workers are at a higher risk of poorer psychological health outcomes than the general population. This begs the question whether lifestyle could play a role in emotional and physical health outcomes, which is an understudied area in this population. This paper reviews health behaviours in paramedics and assesses the...

Prehospital thrombolysis for STEMI where PPCI delays are unavoidable

Background: Primary percutaneous coronary intervention (PPCI) is the gold standard for treating patients experiencing ST-elevation acute myocardial infarction (STEMI). More than 30 000 patients experience cardiac arrest out of a hospital setting in the UK every year and may be some distance from a PPCI facility. Aims: To analyse and consider if a better outcome could be achieved for patients if PPCI was an adjunct to thrombolytic therapy, where delays of ≥60 minutes are inevitable or...

Feasibility of phenytoin as a paramedic-led second-line anti-epileptic drug

Background: Convulsive status epilepticus (CSE) is a medical emergency that is commonly encountered in the prehospital setting. In almost all prehospital settings, treatment is limited to benzodiazepines even though the standard of care in emergency departments includes second-line agents such as phenytoin. Methods: A literature search was conducted using PubMed and Google Scholar using the search terms ‘phenytoin’, ‘seizure’ or ‘convulsive’ and ‘prehospital’, ‘EMS’ or ‘ambulance’ or...

Development of V-FAST: a vision screening tool for ambulance staff

Background: About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Methods: The educational package was developed through focus...

Prehospital sepsis care in Ireland: an audit

Background: Sepsis is a life-threatening illness that requires early recognition and treatment. In Ireland, mortality, while improving, remains at 17% for adults and in a range of 2–4% in children aged under16 years. Prompt, accurate recognition of severe sepsis in the prehospital period could improve outcomes in patients with severe sepsis. Aim: This study aimed to audit the prehospital care of patients with sepsis against national Irish sepsis clinical practice guidelines and identify areas...

Treating sepsis in the emergency prehospital setting with IV antibiotics

Background: The effectiveness of intravenous (IV) antibiotics for the treatment of sepsis in UK prehospital emergency care is not fully understood. In addition, the views of the key clinical decision-makers in ambulance services have not been documented. Aims: This study aimed to provide contemporary, primary data on the opinions of medical directors from across the UK on the use of IV antibiotics to treat sepsis in prehospital emergency care. Methods: A qualitative methodology was used....

Paramedics' perceptions and experiences of NHS 111 in the south west of England

Background: NHS 111 is a non-emergency telephone triage service in England, where people with non-urgent health problems or questions can gain access to information and services. However, studies have demonstrated key problems with the burden it places on emergency and ambulance services. Aim: To add to the evidence base, this study explores the perceptions and experiences of paramedics who attend patients referred to the ambulance service by NHS 111. Methods: A qualitative research design...

Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol

Background: Since 2016, critical care paramedics from the South East Coast Ambulance Service have offered neuromuscular blockade to patients for ventilatory/airway control after cardiac arrest. Aims: To examine the first cases of paramedic-delivered neuromuscular blockade, and evaluate the prevalence of its use and safety. Methods: Retrospective service evaluation of patients receiving post-arrest paralysis during the study period from 1 April 2016 until 31 July 2017. Findings: The study...

A comparison of handover communication in NHS and military emergency care

Background: There is a gap in the literature comparing communication during handover between military and NHS emergency care settings. Objectives: This study aimed to explore differences in handover communication in the NHS and the military, and to understand how paramedics manage the transition between settings. Design: This was a qualitative study for which 13 paramedics were interviewed. It focused on handover communication in NHS emergency care settings and Camp Bastion Hospital,...

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