Research

Improving post-resuscitation care after out-of-hospital cardiac arrest

Thursday, January 2, 2020

Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA...

Prehospital amputation: a scoping review

Background: Where limbs or extremities become entrapped and it is not possible to extricate a patient in time to prevent death, or because of a deterioration or scene safety emergency, prehospital amputation is an option to enable extrication. Aims: This study aimed to analyse accounts of prehospital amputation and identify factors that may influence practice as well as areas for further research. Methods: A search of multiple databases (AMED, BNI, CINAHL, EMCARE, Google Scholar and PubMed)...

Effect of placental transfusion on neonatal resuscitation attempts

Objective: Overall, neonatal mortality has been shown to be reduced by: placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth); delayed cord clamping (DCM) (waiting for the umbilical cord to stop pulsating before clamping and cutting the cord); and umbilical cord milking (UCM) (clamping and cutting the cord immediately before milking the cord towards the neonate to expel remaining volume). This systematic review aimed to determine whether...

Maximising intraosseous flow rates: an in-vitro study

Background: Attaching a different or using no extension set with intraosseous (IO) needles may affect the time taken to administer fluid. An in-vitro study measured this effect. Methodology: Three methods of administration were examined (10 experiments for each approach): a fluid-giving set directly placed in the IO needle hub (direct-to-hub: DTH); a fluid-giving set connected to the EZ-IO device extension set (EZ set: EZS); and a fluid-giving set connected to a simple three-way extension set...

A pilot of the Paramedic Advanced Resuscitation of Children (PARC) course

Paramedics are the primary providers of prehospital care to children in an emergency. However, they deal with children's emergencies infrequently, and consistently report a lack of confidence in this area. The Royal College of Paediatrics and Child Health standards state that clinicians with Advanced Paediatric Life Support (APLS) training or equivalent must be available at all times to deal with emergencies involving children. While APLS is widely recognised as the gold standard in paediatric...

Examining the type and frequency of incidents attended by UK paramedics

Various factors have widened the variety of incidents that UK paramedics, practising in a non-specialist role, may be required to attend. This study set out to identify the type and frequency of incidents attended by paramedics, as well as establishing whether geographical location and time of year bear any influence. The study involved a quantitative retrospective review of paramedic-completed patient clinical records, across two locations and the span of 1 year. Results demonstrated the...

A cross-sectional study of child injury ambulance call-out characteristics and their utility in surveillance

Background: Injuries are a leading cause of death and ill health in children. Aims: To explore the potential utility of ambulance call-out data in understanding the burden and characteristics of child injury. Methods: A cross-sectional examination was carried out of injury-related ambulance callouts to children aged 0–14 years in the north west of England between April 2016 and March 2017. Findings: The majority of the 16 285 call-outs were for unintentional injuries (91.4%), with falls...

Is prehospital lactate testing useful in improving clinical assessment?

Introduction: Lactate devices offer the potential for paramedics to improve patient triage and escalation of care for specific presentations. There is also scope to improve existing prehospital tools by including lactate measurement. Method: A literature search was conducted using the Medline, CINAHL, Academic Search Premier, Sciencedirect and Scopus databases. Findings: Acquiring prehospital lactate measurement in trauma settings improved triage and recognition of the need for critical...

Attitudes and perceptions of paramedics about end-of-life care: a literature review

Background: Paramedics must be prepared to respond to crises in which a threat to a patient's health may result in death. They are therefore highly involved with end-of-life care. Aims: Involvement with end-of-life care is the context in which this paper examines how paramedics perceive and respond to this part of their role. Methods: This is a systematic literature review that examines current evidence. Findings: Five themes emerged, which suggest that paramedics are not prepared to work...

‘Do not attempt CPR’ in the community: the experience of ambulance clinicians

Background: Ambulance clinicians must make time-critical decisions concerning treatment and resuscitation. Little is known about the impact of the presence (or absence) of do-not-attempt cardiopulmonary resuscitation (DNACPR) decision forms in the community. Aims: To investigate ambulance clinicians' experiences of DNACPR documentation and views concerning potential future changes. Methods: This multi-methods study used semi-structured face-to-face interviews (<i>n</i>=10) and an online...

Home visits from paramedic practitioners in general practice: patient perceptions

Background: As set out in the General Practice Forward View (NHS England, 2016), the success of general practice will rely on new ways of working, including having a multidisciplinary workforce. The role of the paramedic practitioner (PP) working within a GP surgery was proposed in a report by the Primary Care Workforce Commission (<xref ref-type="bibr" rid="B12">Health Education England, 2015</xref>). The role involves PPs having their own clinics within the GP surgery, managing a variety of...

Military and civilian handover communication in emergency care: how does it differ?

There is a growing body of literature on handover communication between prehospital and hospital receiving teams in civilian emergency care settings but little is known about how this differs from handover in the UK military medical services. This literature review shows that civilian handover is a complex process conducted in less-than-ideal circumstances, and it is affected by human behaviour and patient factors. There is a debate around standardisation including the use of the Mechanism,...

Prehospital care in isolated neck of femur fracture: a literature review

Around 65 000 people experience a fractured neck of femur (NOF) each year in the UK. It is estimated that one in 10 patients with an NOF fracture will die within 1 month, and one in three will die within 1 year. The bill for NOF fracture, excluding substantial social care costs, is £1 billion per year. Given the exposure that ambulance services have to these patients, several aspects of NOF fracture care could be improved in the prehospital environment, which could also generate significant...

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