Research

Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol

Saturday, May 2, 2020

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...

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...

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