Research

Prehospital sepsis care in Ireland: an audit

Thursday, July 2, 2020

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....

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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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Point-of-care testing by paramedics using a portable laboratory: an evaluation

Use of point-of-care testing (POCT) equipment by paramedics for triage may reduce unnecessary attendance in emergency departments and inconvenience to patients. A hospital pathology service and an ambulance trust wanted a system for safe and effective use of diagnostic devices by paramedics at the patient bedside. A suite of POCT devices to perform an expanded repertoire of pathology tests was provided, along with technology for electronic data capture, temperature control and monitoring, in a...

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

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...

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