Ryan P Strum, Walter Tavares, Andrew Worster, Lauren E Griffith, Ahmad Rahim, Andrew P Costa
INTRODUCTION: Ontario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care-like patient conditions. OBJECTIVE: To construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data...
January 20, 2021: BMJ Open
H van Woerden, M Bucholc, B Clubbs Coldron, V Coates, J Heaton, M McCann, N Perrin, R Waterson, A Watson, S MacRury
AIM: To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions. METHODS: A national retrospective data set including 30 999 diabetes-related callouts from the Scottish Ambulance Service was utilized covering a 5-year period between 2013 and 2017. The relationship between diabetes-related hospital conveyance and seven potential risk factors was analysed...
August 15, 2020: Diabetic Medicine: a Journal of the British Diabetic Association
Debbie Scott, Rowan P Ogeil, Foruhar Maoyeri, Cherie Heilbronn, Kerri Coomber, Karen Smith, Peter G Miller, Dan I Lubman
There is substantial evidence supporting the association between alcohol license density and violent crime. However, the impact of different types of alcohol licenses on intimate partner and family violence is sparse. We explored the associations between access to alcohol outlets, and family and intimate partner violence using paramedic clinical records, given this service is often the first to respond to acute crises. Coded ambulance attendance data from 694 postcodes in Victoria, Australia, from July 1, 2016 to June 30, 2018 where alcohol or another drug, mental health or self-harm associated with family or intimate partner violence was indicated were examined...
January 18, 2021: Journal of Interpersonal Violence
Thaddeus J Puzio, Joseph D Love, Michelle K McNutt, Christopher T Stephens, John A Harvin, Rudy Cabrera, Lillian S Kao, Bryan A Cotton, Charles E Wade, David E Meyer
BACKGROUND: Protocols for expediting critical trauma patients directly from the helipad to the operating room tend to vary by center, rely heavily on physician gestalt, and lack supporting evidence. We evaluated a population of severely injured trauma patients with the aim of determining objective factors associated with the need for immediate surgical intervention. METHODS: All highest-activation trauma patients transported by air ambulance between 1/1/16 and 12/31/17 were enrolled retrospectively...
January 15, 2021: Journal of Surgical Research
T K Priya, Venkatachalam Jayaseelan, Yuvaraj Krishnamoorthy, Manikandanesan Sakthivel, Marie Gilbert Majella
Introduction: Type 2 diabetes mellitus has huge economic burden for both patient and health-care system. Management of the condition in India faces multiple challenges such as paucity of trained medical and paramedical staff, poor quality, lack of satisfaction with services, and unaffordability of services. Objective: To determine the level of satisfaction and the out-of-pocket expenditure for type 2 diabetes patients receiving treatment from public and private sectors in urban Puducherry...
December 2020: Journal of Patient Experience
Kate Dillon, Chris Hook, Zoe Coupland, Pascale Avery, Hazel Taylor, Andy Lockyer
Background: The coronavirus disease 2019 (COVID-19) results in hypoxia in around a fifth of adult patients. Severe hypoxia in the absence of visible respiratory distress ('silent hypoxia') is increasingly recognised in these patients. There are no published data evaluating lowest recorded pre-hospital oxygen saturation or pre-hospital National Early Warning Score 2 (NEWS2) as a predictor of outcome in patients with COVID-19. Methods: In this retrospective service evaluation, we included adult inpatients with laboratory confirmed COVID-19 who were discharged from hospital or who died in hospital between 12 March and 28 April 2020 (n = 143)...
December 1, 2020: British paramedic journal
Harriet Ashman, Dean Rigg, Fionna Moore
Background: Although burn emergencies are infrequently encountered, the ambulance service is often the first point of contact for patients in these situations. It is therefore important that these potentially devastating injuries are managed in accordance with the evidence base. Appropriate assessment and management of these patients in the pre-hospital phase will have a significant impact upon their long-term outcomes, such as scarring cosmesis and functionality. Aim and objectives: This audit was conducted to determine if patients presenting to one UK ambulance service with thermal burn injuries were managed safely, effectively and in a timely manner...
December 1, 2020: British paramedic journal
Gregory Adam Whitley, Scott Munro, Pippa Hemingway, Graham Richard Law, Aloysius Niroshan Siriwardena, Debbie Cooke, Tom Quinn
Healthcare is becoming increasingly complex. The pre-hospital setting is no exception, especially when considering the unpredictable environment. To address complex clinical problems and improve quality of care for patients, researchers need to use innovative methods to create the necessary depth and breadth of knowledge. Quantitative approaches such as randomised controlled trials and observational (e.g. cross-sectional, case control, cohort) methods, along with qualitative approaches including interviews, focus groups and ethnography, have traditionally been used independently to gain understanding of clinical problems and how to address these...
December 1, 2020: British paramedic journal
Bethany Wheeler, Enrico Dippenaar
Background: Simulation is a broad concept used as an education pedagogy for a wide range of disciplines. The use of simulation to educate paramedics is a frequently used but untested modality to teach psycho-motor skills, acquire new knowledge and gain competence in practice. This review identifies how simulation is currently being used for the education of paramedics, and establish the context for future application. Methods: A scoping review of the literature was undertaken following the PRISMA systematic approach...
December 1, 2020: British paramedic journal
Simon Robinson, Jordan Kirton
Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing...
December 1, 2020: British paramedic journal
Gordon W Fuller, Steve Goodacre, Samuel Keating, Esther Herbert, Gavin Perkins, Matthew Ward, Andy Rosser, Imogen Gunson, Joshua Miller, Mike Bradburn, Tim Harris, Cindy Cooper
Introduction: Acute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure. Methods: A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial...
December 1, 2020: British paramedic journal
Peter Eaton-Williams, Jack Barrett, Craig Mortimer, Julia Williams
Objectives: Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. Methods: Between 4 November 2019 and 5 January 2020, registered paramedics from nine English NHS ambulance service trusts were invited to complete an online questionnaire...
December 1, 2020: British paramedic journal
Karl Charlton, Matt Capsey, Chris Moat
Background: The weight of children provides the cornerstone of their clinical management, as many drug dosages, equipment sizes, fluid boluses, as well as DC shock energy, are administered on a per kilogram basis. Children who attend hospital are weighed using scales prior to receiving these interventions. This is not possible in the pre-hospital environment. A paucity of evidence exists to support the page for age weight guidance indicated by JRCALC, and it remains unknown if this approach meets the reference standard of 70% of estimations within 10% of actual weight and 95% within 20% of actual weight...
December 1, 2020: British paramedic journal
Matthew Metcalf, Matthew Robinson, Pippa Hall, James Goss
Aim: This service evaluation seeks to determine whether the pre-hospital Cardiac Arrest Support Tier (CAST), implemented by a Hazardous Area Response Team (HART), was clinically effective, feasible and acceptable during its pilot year. Methods: Chest compression feedback, provision of Return of Spontaneous Circulation (ROSC) care and CAST paramedic exposure to Out-of-Hospital Cardiac Arrest (OHCA) were audited. The number of incidents that CAST responded to and the number of staff it committed were also assessed...
September 1, 2020: British paramedic journal
Stian A Mohrsen
Introduction: Vagus nerve stimulation (VNS) is an adjunct therapy to anti-epileptics in patients where combination drug therapy alone has failed. The VNS device resembles an implantable defibrillator, and can be found underneath the clavicle on either side of the chest. By using a strong ring magnet, the device can be manipulated to seize function or operate on higher intensities, depending on how it is applied. The use of vagal stimulation is increasingly common and VNS is being explored for a range of other medical complaints...
September 1, 2020: British paramedic journal
Alison Rae, Simon Robinson
Introduction: The development of safe, competent and capable paramedics is one of the key concerns of education providers or Higher Education Institutions (HEIs). To achieve this, paramedic programmes need to focus on teaching leadership to students. The aim of this literature review was to identify the current leadership development opportunities for paramedic students during their undergraduate training across the United Kingdom, in order to identify current gaps and make suggestions on how HEIs could increase leadership opportunities for student paramedics...
September 1, 2020: British paramedic journal
Jamie Scott
Background: Falls in older populations constitute a large proportion of the workload for UK ambulance services, and cost the NHS over £2.3 billion per year. A large proportion of older fallers are not conveyed to an emergency department (ED), representing a vulnerable group of patients. New pathways have been developed for paramedics to refer this group directly to falls prevention services. Objectives: This study aimed to investigate the re-contact rates and characteristics of service users aged ≥ 65 years who fell and were referred to a falls prevention service by paramedics, and to describe the characteristics of those who re-contacted the ambulance service after referral...
September 1, 2020: British paramedic journal
Graham McClelland, Karl Charlton, Jacqueline Mains, Karen Millican, Caroline Cullerton
Background: Ambulance services transport patients with infections and diseases, and could pose a cross-transmission risk to patients and staff through environmental contamination. The literature suggests that environmental pathogens are present in ambulances, cleaning is inconsistent and patient/staff impact is difficult to quantify. Eco-Mist developed a dry misting decontamination system for ambulance use called AmbuGard, which works in < 30 minutes and is 99.9999% effective against common pathogens...
September 1, 2020: British paramedic journal
Samantha Laws, Chao Wang, Mary Halter
Introduction: Changes in the paramedic profession have seen an increased range of medicines available within UK ambulances services. However, poor practice in medicines management has been identified by the Care Quality Commission. Literature in this area is sparse. This study aimed to determine the perceived knowledge, attitudes and practices of paramedics regarding pharmacology and the legal and regulatory issues of medicines management and administration. Methods: The study utilised a cross-sectional survey design, administering an anonymous online survey to all (approximately 1000) paramedics within one UK NHS ambulance trust...
September 1, 2020: British paramedic journal
Anthony Platt
Background: In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI)...
June 1, 2020: British paramedic journal
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