Research

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...

Prehospital airway management

The prehospital emergency airway management is a key moderating factor for patient survival and mortality rates. There has been much debate around the optimum method of prehospital emergency airway management. This commentary critically appraises a recent systematic review which assesses the harms and benefits of three different airway management strategies for a range of emergency clinical scenarios.Commentary on: Carney N, Totten AM, Cheney T et al. Prehospital Airway Management: A Systematic...

Point-of-care blood testing with secondary care decision support for frail patients

Aim: A service evaluation was conducted to assess the feasibility and impact of a pilot service to facilitate alternatives to hospital admission for frail patients in supportive care settings. Paramedic assessments were enhanced by point-of-care testing and telephone support from senior physicians. Method: A rapid response vehicle, staffed by a specialist paramedic and equipped with the Abbott i-STAT Wireless 1 point-of-care testing platform that could transmit results to hospital electronic...

Acute medical condition of patients with femoral neck fracture

The main objective of this study was to analyse the acute medical condition of patients at the earliest possible time after femoral neck fracture. Emergency medical services (EMS) data from five counties and cities in the state of Hesse, Germany, over 2017–2019 were analysed. The highest incidence of fracture was in those aged 80 years or above. Of all patients, 94.57%–95.49% were admitted to hospital for inpatient care, 3.40%–4.41% for outpatient care and 0.25%–0.60% for immediate intervention....

Burnout in frontline ambulance staff

Background: Staff retention is a significant issue for ambulance services across the globe. Exploratory research, although minimal, indicates that stress and burnout, in particular, influence attrition within the paramedic profession. These need to be understood if their impact on retention is to be addressed. Aims: To determine the presence of and contributory factors for burnout in the ambulance service to inform recommendations for positive change. Methods: A two-phased survey approach...

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