Research

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

February 2019

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,...

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

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...

Examining the benefits of paramedic engagement for the novice researcher

Background:Paramedics new to research need to know how to optimise the quality of proposed research studies. A prehospital mixed-methods study design required guidance, not only from an academic perspective but also from experts within paramedicine. Paramedic engagement was defined as an exercise where paramedic researchers and paramedic clinical academics could be involved as advisory professionals.Aim:The aim of this paramedic engagement was the revision of a proposed research design on how...

Cerebral oximetry monitoring in OHCA

Background:Cerebral oximetry allows non-invasive, real-time monitoring information of cerebral blood flow to be carried out. It has recently been used to provide information about cerebral perfusion during resuscitation efforts in cases of cardiac arrest and may give an indication of neurological survival. Most of this information has been obtained during the hospital phase of treatment and little is known about cerebral flow in the prehospital phase.Methods:A systematic review was carried out,...

Rapid recognition tools for subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) carries a substantial burden of morbidity and mortality—therefore, the development of methods to rapidly detect SAH with high sensitivity is very important. Paramedics are frequently called to patients complaining of headache and the treatment for patients with clinically likely SAH is mostly straightforward for prehospital clinicians. However, a number of patients present with atypical symptoms and 12% of all SAHs are overlooked on initial assessment (Kowalski et...

Paramedics' perceptions and experiences of pelvic injuries in prehospital situations

Mortality rates remain high in patients with pelvic injuries despite improvements in trauma care in recent years. Pelvic injuries are associated with patients with a high Injury Severity Score (ISS); it can therefore be difficult to distinguish whether the pelvic injury was a primary causative factor of mortality. ‘Open book’ fractures carry a mortality rate as high as 50% and clinicians should therefore have a low threshold for suspecting a pelvic injury. Paramedics should follow the latest...

Pelvic binder placement in a regional trauma centre

Background:Pelvic circumferential compression devices (PCCDs) are a life-saving prehospital adjunct to trauma care. Correct positioning at the level of the trochanters maximises their efficacy.Methods:To examine the positioning of PCCDs in a regional trauma centre in England, a retrospective analysis of patients who had experienced major trauma was carried out over a 6-month period. The primary outcome of PCCD position was assessed using computerised tomography imaging and recorded as ‘high’,...

Ketamine administration by HART paramedics: a clinical audit review

Hazardous Area Response Team (HART) paramedics from a single ambulance service Trust were trained to administer ketamine up to 0.5 mg/kg for analgesia in the pre-hospital environment. The Trust's special operations department felt that, in doing so, patient care could be improved in both hazardous areas and regular pre-hospital clinical situations. After completing a written examination and scenario training on the relevant Trust patient group directive (PGD), HART paramedics were authorised...

Adult intraosseous access: a comparison of devices

Background:Evidence to support device choice in intraosseous access is lacking in UK paramedic practice. Being unable to access the sternum with devices may result in under-treatment because of the inability to gain timely vascular access. This represents a shortcoming in current practice and a need for further research.Method:A literature review was conducted to find suitable studies and these were critically appraised. The data were synthesised to draw conclusions that could either influence...

A qualitative exploration of current paramedic cardiac auscultation practices

This exploratory study addresses the current paucity of knowledge available in UK paramedic practice in relation to cardiac auscultation. There is a recognised lack of data surrounding the efficacy, safety and relevance of patient assessment skills in the pre-hospital setting in general, and cardiac auscultation specifically. This study provides information about current paramedic practice, and provides a basis for further research in this area. An online survey was distributed using convenience...

Secondary traumatic stress and resilience among EMS

Aim:The current study investigated the positive and negative psychological adaptations that are a result of secondary traumatic stress, and the role of resilience among paramedics and emergency medical technicians (EMTs).Methods:Emergency medical service (EMS) providers anonymously completed four validated questionnaires on: secondary traumatic stress, post-traumatic growth, resilience, and changes in outlook. Relationships between these constructs and demographics were...

Paramedic views on clinical research in cardiac arrest

Background:The success of pre-hospital research relies on positive engagement from paramedics. Without adequate participation and protocol compliance, trials will not succeed.Aims:The aims of the current research were to seek feedback from paramedics about trial participation and determine their views and preferences regarding a large-scale research study in future.Methods:Paramedics participating in REVIVE-Airways, a trial of airway management in out-of-hospital cardiac arrest, were sent a...

Cooling of thermal burn injuries: a literature review

Correct initial management of thermal burns is key in promoting patient outcomes. Cooling burns with cool running water (CRW) for 20 minutes has been shown to accelerate the wound healing process, improve cosmetic outcomes and prevent burn progression. This literature review aims to increase understanding of this simple first aid (FA) intervention, help inform paramedic practice, and determine areas for further research. Three themes came to light following systematic searching of the available...

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