Research

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

July 2019

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...

‘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...

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...

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,...

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

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...

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