Spotlight on Research

The efficacy of the HEART score in prehospital settings

Background: HEART scores are a well-validated tool used to risk stratify patients with chest pain in the emergency department. Currently, no triage or risk stratification tool is available in the UK prehospital arena. Methods: A comprehensive literature search was carried out to determine the effectiveness of HEART score use by paramedics in the prehospital environment. Findings: Prehospital HEART scores completed by paramedics appear to have a high sensitivity and negative predictive value...

Predicting conveyance to the emergency department for older adults who fall

Background: Falls are frequent in older adults and are associated with high mortality, morbidity and immobility. Many patients can be managed in the community, but some will require conveyance to the emergency department (ED). Aims: This study aims to identify predictive characteristics of conveyance to the ED after a fall. Methods: A cross-sectional study between December 2018 and September 2020 involved patients attended by a falls rapid response service. Eligible patients were aged ≥60...

Prognostic value of lactate in out-of-hospital cardiac arrest: a prospective cohort study

Background: The prognostic role of lactate in out-of-hospital cardiac arrest (OHCA) remains unclear. Aims: To explore serum lactate as a predictor of return of spontaneous circulation in patients experiencing OHCA after arrival at hospital. Methods: This 13-month prospective observational cohort study involved patients aged ≥18 years. Serum lactate levels were measured during cardiopulmonary resuscitation before ROSC. Patients were divided into two groups by lactate level: Group 1, low...

Air ambulance outcomes of out-of-hospital cardiac arrest seen in the pandemic

Introduction: COVID-19 was declared a global health pandemic in March 2020, and national lockdowns were imposed in an attempt to limit the spread of the virus. Several studies have reported significant increases in the number of out-of-hospital cardiac arrest (OHCA) attendances coupled with a reduction in return of spontaneous circulation (ROSC). This is the first study to report the characteristics and outcomes from OHCA in a UK air ambulance setting. Methods: A retrospective database review...

Awareness and use of prone position for awake patients with suspected COVID-19

Introduction: Evidence is growing that prone positioning may be a simple, safe, and effective technique to improve oxygenation in awake patients with COVID-19 who are unresponsive to initial therapy. However, there is little evidence about its use in the prehospital environment. This study explores clinician awareness and experiences of this in a large ambulance service in south east England. Methods: An online survey was distributed to 3377 operational ambulance clinicians working for the...

Prehospital point-of-care biomarkers: missing link in acute myocardial infarction?

Coronary heart disease is a leading cause of death worldwide. Paramedics are instrumental in the treatment, triage and transport of patients experiencing acute coronary syndromes and acute myocardial infarction (AMI). Paramedics currently rely on prehospital electrocardiography and patient symptomology to diagnose AMI, which may result in missed diagnoses. Point-of-care biomarkers such as cardiac troponin (cTnT) and copeptin may have the potential to increase the diagnostic capabilities of...