Ambulance Service NHS Foundation Trust Research Articles

Rural versus urban out-of-hospital cardiac arrest response, treatment and outcomes in the North East of England from 2018 to 2019.

Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency. There is international evidence to suggest that rural regions experience worse OHCA outcomes, such as reduced survival rates. The aim of this study was to quantitatively review and compare the OHCA response, treatment and pre-hospital outcomes in a single-centre ambulance service over a 1-year period in urban and rural areas. This study used retrospective OHCA audit data from the North East Ambulance Service NHS Foundation Trust, from April 2018 to April 2019, comparing OHCA response, treatment and return of spontaneous circulation (ROSC) data in relation to urban or rural classification status, using the UK government urban-rural classification tool. A total of 1295 urban cases and 319 rural cases were compared. Bystander public-access defibrillator (PAD) use was higher in rural areas in comparison to urban areas (20/319 (6.3%) vs 47/1295 (3.6%); p = 0.03). The mean ambulance response time was slower in rural areas (10:43 minutes (n = 319) (SD ± 8.2) vs 07:35 minutes (n = 1295) (SD ± 7.1); p = < 0.01). Despite this, overall ROSC rates at hospital were similar between the groups, with no statistically significant difference (rural: 87/319 (27.3%) vs urban: 409/1295 (31.6%); p = 0.14).A further sub-group analysis of initially shockable OHCA cases showed slower ambulance response times in rural areas (10:45 minutes (n = 68) (SD ± 12.3) vs 07:55 minutes (n = 245) (SD ± 5.5); p = < 0.01) and that rural cases experienced lower ROSC at hospital rates (31/68 (45.6%) vs 151/245 (61.6%); p = 0.02). This report showed differences in OHCA response and outcomes between rural and urban settings. In the shockable OHCA sub-group analysis, rural areas had slower ambulance response times and lower ROSC rates. The longer ambulance response times in the rural shockable OHCA group could be a factor in the reduced ROSC rates. Linking hospital survival data should be used in future research to explore this area further.

Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review

ObjectiveIn the UK there are around 5400 deaths annually from injury. Tranexamic acid (TXA) prevents bleeding and has been shown to reduce trauma mortality. However, only 5% of UK major...

Aspirin for suspected stroke patients?

Journal of Paramedic PracticeVol. 15, No. 3 CommentAspirin for suspected stroke patients?Graham McClellandGraham McClellandEmail:E-mail Address: [email protected]Visiting Clinical Researcher, Newcastle University; Paramedic Research Fellow, North East Ambulance Service NHS Foundation Trust, Newcastle Upon Tyne, UKSearch for more papers by this authorGraham McClellandPublished Online:6 Mar 2023https://doi.org/10.12968/jpar.2023.15.3.98AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bath PM, Woodhouse LJ, Krishnan K et al.. Prehospital Transdermal Glyceryl Trinitrate for Ultra-Acute Intracerebral Hemorrhage: data From the RIGHT-2 Trial. Stroke. 2019;50:3064–3071. Crossref, Google ScholarBerkowitz AL, Westover MB, Bianchi MT, Chou SH. Aspirin for acute stroke of unknown etiology in resource-limited settings: a decision analysis. Neurology. 2014;83:787–793. Crossref, Google ScholarChen ZM, Sandercock P, Pan HC et al.. Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000;31:1240–1249. Crossref, Google ScholarNational Institute for Health and Care Excellence. Stroke and tranisent ischaemic attack in over 16s: diagnosis and initial management [NG128]. 2019. https://www.nice.org.uk/guidance/ng128/evidence/a-aspirin-pdf-6777399566 (accessed 22 February 2023) Google ScholarNational Institute for Health and Care Excellence.. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management [NG128]. 2022. https://www.nice.org.uk/guidance/ng128 (accessed 22 February 2023) Google ScholarPrust ML, Saylor D, Zimba S et al.. Inpatient management of acute stroke of unknown type in resource-limited settings. Stroke. 2022;53:e108–e117. Crossref, Google ScholarQuaas J. Aspirin given immediately for a major heart attack (STEMI). 2009. https://www.thennt.com/nnt/aspirin-for-major-heart-attack/ (accessed 22 February 2023) Google ScholarRothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet. 2016;388:365–375 Crossref, Google ScholarSaver JL, Eckstein M, Stratton S et al.. The field administration of stroke therapy - Magnesium (FAST-MAG) phase 3 trial: Primary results. Stroke. 2014;45. Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 15Issue 3ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 6 March 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Training the trainers: improving the quality of education delivered to paramedics through a simulation-debrief model.

Education and training delivered within ambulance services is vital to clinicians maintaining competence, confidence and currency. Simulation and debrief in medical education aims to imitate clinical experience and provide real-time feedback. The South Western Ambulance Service NHS Foundation Trust employs senior doctors in their learning and development (L&D) team to support the development of 'train the trainer' courses for L&D officers (LDOs). This short report of a quality improvement initiative describes the implementation and evaluation of a simulation-debrief model of paramedic education. A quality improvement design was adopted. The train the trainer scenarios for simulation-debrief were designed and written following the trust's training needs analysis by the L&D team. The course ran for two days, and each scenario was facilitated by faculty experienced in simulation (both doctors and paramedics). Low-fidelity mannequins and standard ambulance training kit was used (including response bags, training monitor and defibrillator). Participants' pre- and post-scenario self-reported confidence scores were recorded, and qualitative feedback requested. Numerical data were analysed, and collated into graphs using Excel. Thematic analysis of comments was used to present qualitative themes. The SQUIRE 2.0 checklist for reporting quality improvement initiatives was used to frame this short report. Forty-eight LDOs attended across three courses. All participants reported improved confidence scores in the clinical topic covered after each simulation-debrief scenario, with a minority reporting equivocal scores. Formal qualitative feedback from participants indicated an overwhelmingly positive response to the introduction of simulation-debrief as an education method, and a move away from summative, assessment-based training. The positive value of a multidisciplinary faculty was also reported. The simulation-debrief model of paramedic education represents a move away from the use of didactic teaching and 'tick box'-style assessments in previous train the trainer courses. The introduction of simulation-debrief teaching methodology has had a positive impact on paramedics' confidence in the selected clinical topics, and is seen by LDOs as an effective and valuable education method.

Recommendation for changes to the guidelines of trauma patients with potential spinal injury within a regional UK ambulance trust.

Spinal assessment and immobilisation has been a topic of debate for many years where, despite an emerging evidence base and the delivery of new guidance overseas, little has changed within UK pre-hospital practice. Since 2018, South East Coast Ambulance Service NHS Foundation Trust has spent time working with local trauma networks and expertise from within the region and international colleagues to develop a set of C-spine assessment and immobilisation guidelines that reflect the current best available international evidence and significant changes in international pre-hospital practice from settings such as Scandinavia and Australasia. A specialist group was commissioned to review the topic of pre-hospital spinal immobilisation and explore potential for evidence-based improvement. In conjunction with local trauma networks, subject matter experts and a thorough review of recent literature, a series of recommendations were made in order to improve spinal care within the authoring trust. Seven recommendations were made, and an updated set of guidelines produced. These included the removal of semi-rigid collars from pre-hospital spinal immobilisation; the creation of two tiers of patients to ensure that the high-risk and low-risk populations are considered separately and an accompanying decision tool to safeguard both cohorts; an increased emphasis on the risk of spinal injury in the frail and older patient; an emphasis on spinal motion restriction rather than rigid immobilisation; an increased emphasis on self-extrication; and the use of a marker for emergency departments. An updated set of guidance has been produced using a combination of specialist and expert opinion alongside a literature review with close involvement of key stakeholders, both public and professional. The new guidance helps to ensure a patient-centred approach where each person is considered an individual with their risk of injury and management measures tailored to their specific needs.

A qualitative exploration of the views of paramedics regarding the identification of cardiovascular risk factors in the pre-hospital environment.

Cardiovascular disease remains the most prominent cause of death in England. Healthcare professionals have been encouraged to identify cardiovascular risk factors (CVRFs). The aim of this study was to explore how paramedics contribute to the identification of CVRFs in the pre-hospital setting, through their role, behaviours and practice. The study took place within the North East Ambulance Service NHS Foundation Trust supported by a National Institute for Health Research clinical research internship. A qualitative approach was used, and a single focus group was conducted. The study recruited participants through advertising for volunteers and purposive sampling. The themes that arose from the focus group allowed the initial exploration of the views of paramedics in relation to role, behaviour and practice in identifying CVRFs. A single focus group with five paramedics was conducted in June 2021. Two central themes emerged: education/health promotion and fear/anxiety. Participants agreed that their role in this area centred around patient education. Participants' behaviours and practice were adversely affected through fear of complaints, fear of hypocrisy and feeling a lack of support from the ambulance service. Participants felt that further training and subsequent indemnity from complaints would improve the likelihood of more direct patient education. Support from the ambulance service to improve employees' own health and well-being was also a key topic of discussion. The study explored the views of a small sample of paramedics on this topic. Patient education was felt to be part of a paramedic's role; however, barriers were identified that prevent paramedics from carrying out this role. Further research is needed to explore these barriers further.

Optimising communication for people with dementia

Journal of Paramedic PracticeVol. 14, No. 5 CommentOptimising communication for people with dementiaRobyn PaintingRobyn PaintingEmail:E-mail Address: [email protected]Paramedic, South Central Ambulance Service NHS Foundation Trust, Southampton, UKSearch for more papers by this authorRobyn PaintingPublished Online:11 May 2022https://doi.org/10.12968/jpar.2022.14.5.214AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Association of Ambulance Chief Executives. UK ambulance services clinical practice guidelines 2016. 5th edn. Version 1.4. Bridgewater: Class Professional Publishing; 2016 Bach SGrant A. Communication and Interpersonal Skills in Nursing. 3rd edn. London: SAGE Publications; 2015 Google ScholarBradford A, Kunik M, Schulz P, Williams S, Singh H. Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors. Alz Dis Assoc Disord. 2009;23(4):306–314. https://doi.org/10.1097/WAD.0b013e3181a6bebc Crossref, Google ScholarCare Quality Commission. Mental Capacity Act 2005: Guidance for providers. 2011. https://tinyurl.com/4e4m77sp (accessed 27 April 2022) Google ScholarCaroline N. Emergency Care in the Streets. 7th edn. Burlington (MA): Jones and Bartlett Learning; 2014 Google ScholarDepartment of Health and Social Care. Living well with dementia: a national dementia strategy. London: The Stationary Office; 2009 Google ScholarFong JH, Anat DS and Longnecker N (2010). Doctor-Patient Communication: A Review. Ochsner J, 10(1), pp. 38–43 Google ScholarGrimme T, Buchanan J, Afflerbach S. Understanding elderspeak from the perspective of certified nursing assistants. J Gerontol Nurs. 2015;41(11):42–49. https://doi.org/10.3928/00989134-20151015-05 Crossref, Google ScholarHealth and Care Professions Council. Standards of proficiency. 2014. https://www.hcpc-uk.org/standards/standards-of-proficiency/paramedics/ (accessed 27 April 2022) Google ScholarHerman R, Williams K. Elderspeak's influence on resistiveness to care: focus on behavioural events. Am J Alzheimers Dis Other Demen. 2009;24(5):417–423. https://doi.org/10.1177/1533317509341949 Crossref, Google ScholarHolt-Lunstad J, Smith T, Layton J. Social relationships and mortality risk: a meta-analytic review. PLoS Med J. 2010;7(7):e1000316. https://doi.org/10.1371/journal.pmed.1000316. Crossref, Google ScholarInstitute for Healthcare Communication. Impact of Communication in Healthcare. 2011. https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/ (accessed 27 April 2022) Google ScholarJootun D, McGhee G. Effective Communication with People who have Dementia’, Nurs Stand. 2011;40(6):40–46. https://doi.org/10.7748/ns2011.02.25.25.40.c8347 Crossref, Google ScholarLang E. A Better Patient Experience Through Better Communication’, J Radiol Nurs. 2012;31(4):114–119. https://doi.org/10.1016/j.jradnu.2012.08.001 Crossref, Google ScholarLombardi N, Buchanan J, Afierbach S, Campana K, Sattler A, Lai D. Is elderspeak appropriate? A survey of certified nursing assistants. J Gerontol Nurs. 2014;40(11):44–52. https://doi.org/10.3928/00989134-20140407-02 Crossref, Google ScholarMiller L. Effective communication with older people. Nurs Stand. 2002;17(9):45–50. https://doi.org/10.7748/ns2002.11.17.9.45.c3298 Crossref, Google ScholarNational Institute for Health and Care Excellence. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services [CG138]. https://www.nice.org.uk/Guidance/CG138 (accessed 27 April 2022) Google ScholarSavundranayagam M, Moore-Nielsen K. Language-based communication strategies that support person-centred communication with persons with dementia. Int Psychogeriatr. 2015;27(10):1707–1718. https://doi.org/10.1017/S1041610215000903 Crossref, Google ScholarWeirather R. Communication strategies to assist comprehension in dementia. Hawaii Med J. 2010;26(3):72–74 Google ScholarWilliams K, Herman R, Gajewski B, Wilson K. Elderspeak Communication: Impact on Dementia Care. Am J Alzheimers Dis Other Demen. 2009;24(1):11–20. https://doi.org/10.1177/1533317508318472 Crossref, Google ScholarWilson R, Rochon E, Mihailidis A, Carol L. Examining success of communication strategies used by formal caregivers assisting individuals with Alzheimer's disease during an activity of daily living. J Speech Lang Hear Res. 2012;55(2):328–341. https://doi.org/10.1044/1092-4388(2011/10-0206 Crossref, Google ScholarWoodward M. Aspects of communication in Alzheimer's disease: clinical features and treatment options. Int Psychogeriatr. 2013;25(6):877–885. https://doi.org/10.1017/S1041610213000318 Crossref, Google ScholarWorld Health Organization. Dementia: key facts. 2021. https://www.who.int/news-room/fact-sheets/detail/dementia (accessed 27 April 2022) Google Scholar FiguresReferencesRelatedDetails 2 May 2022Volume 14Issue 5ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 11 May 2022 Published in print 2 May 2022 Information© MA Healthcare LimitedPDF download

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 South East Coast Ambulance Service NHS Foundation Trust to assess their awareness of using the prone position for patients with suspected COVID-19 and their experiences of its use in their practice. Results: A total of 278 respondents completed the survey, of whom 229 were aware of the use of the prone position for awake patients with COVID-19 and 18 had attempted to use it in their practice. Ten reported improvements in clinical observations and patient comfort, and six patients showed clinical improvement only. There were no reports of deterioration. The most common reason for not attempting prone positioning was the absence of formal training or guidance. Conclusion: Ambulance clinicians are aware of the use of the prone position for patients with COVID-19 and a small number have used it. The majority of clinicians who were aware of the procedure did not use it because of the lack of guidance or concerns over patient safety. When attempted, prone positioning in prehospital practice may be an example of practice borne of ‘clinical courage’. Further research is needed before the prone position can be routinely used in prehospital practice.

Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation

BackgroundDrug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it.MethodsWe conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie.ResultsThere were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the second attempt and 100% on the third attempt,ConclusionSpecialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass success and high overall success and are therefore both safe and competent at this intervention.

Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study.

Introduction:Stroke is one of the leading causes of death and disability worldwide. The ambulance service is often the first medical service to reach an acute stroke patient, and due to the time-critical nature of stroke, a time-critical assessment and rapid transport to a hyper acute stroke unit are essential. As stroke services have been centralised, different hospitals have implemented different pre-alert admission policies that may affect the on-scene time of the attending ambulance crew. The aim of this study is to investigate if the different pre-alert admission policies affect time on scene.Method:The current study is a retrospective quantitative observational study using data routinely collected by North East Ambulance Service NHS Foundation Trust. The time on scene was divided into two variables; group one was a telephone pre-alert in which a telephone discussion with the receiving hospital is required before they accept admission of the patient. Group two was a radio-style pre-alert in which the attending clinician makes an autonomous decision on the receiving hospital and alerts them via a short radio message of the incoming patient. These times were then compared to identify if there was any difference between them.Results:Data on 927 patients over a three-month period, from October to December 2019, who had received the full stroke bundle of care, were within the thrombolysis window and recorded as a stroke by the attending clinician, were split into the variable groups and reported on. The mean time on scene for a telephone call pre-alert was 33 minutes and 19 seconds, with a standard deviation of 13 minutes and 8 seconds. The mean on-scene time for a radio pre-alert was 28 minutes and 24 seconds, with a standard deviation of 11 minutes and 51 seconds.Conclusion:A pre-alert given via radio instead of via telephone is shown to have a mean time saving of 4 minutes and 55 seconds, representing an important decrease in time which could be beneficial to patients.

Hangings attended by emergency medical services: a scoping review.

Background:In the United Kingdom (UK) there were 6507 deaths by suicide in 2018, with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted. Trauma audits conducted by North East Ambulance Service NHS Foundation Trust have identified an increased trend in hanging cases, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice.Methods:A five-stage scoping review method was used. Relevant studies were identified by searching MEDLINE, CINAHL, EMBASE and EMCARE with the help of the Library and Knowledge Service for NHS Ambulance Services in England. Grey literature and reference lists were also searched. Studies were included based on relevance to hangings attended by EMS. Data were tabulated and narratively synthesised.Results:Sixteen papers were included in the review. Australia was the most frequent source of studies (n = 5, 31%). Most studies (n = 11, 69%) were published in the past 10 years. The median sample size was 53 (IQR 41–988, range 10–3981). All papers included varying levels of patient characteristics, EMS input and patient outcomes.Conclusion:Hanging is a highly lethal method of suicide that is increasingly used in the UK. This scoping review found that there is scarce literature focused on hangings attended by EMS. Treatment of the hanging patient in cardiac arrest is described in many of the papers included. Hanging patients may benefit from the presence of specialist resources who can deliver interventions such as sedation and advanced airway management. The psychological impact of attending, or witnessing, hanging patients is an area that needs further consideration. Further research is needed to describe and improve EMS treatment of hangings.

Call to hospital times for suspected stroke patients in the North East of England: a service evaluation

Introduction:Stroke is a leading cause of mortality and morbidity. The role of the ambulance service in acute stroke care focuses on recognition followed by rapid transport to specialist care. The treatment options for acute ischaemic strokes are time dependent, so minimising the pre-hospital phase of care is important. The aim of this service evaluation was to report historical pre-hospital times for suspected stroke patients transported by the North East Ambulance Service NHS Foundation Trust (NEAS) and identify areas for improvement.Methods:This was a retrospective service evaluation using routinely collected data. Data on overall call to hospital times, call to arrival times, on scene times and leave scene to hospital are reported.Results:Data on 24,070 patients with an impression of stroke transported by NEAS between 1 April 2011 and 31 May 2018 are reported. The median call to hospital time increased from 41 to 68 minutes, call to arrival from 7 to 17 minutes, on scene from 20 to 30 minutes and leave to hospital from 12 to 15 minutes.Conclusion:The pre-hospital call to hospital time for stroke patients increased between 2011 and 2018. The call to arrival phase saw a sharp increase between 2015 and 2017, whereas on scene and leave scene to hospital saw steadier increases. Increasing demand on the ambulance service, reorganisation of regional stroke services and other factors may have contributed to the increase in times. Reducing the on scene phase of pre-hospital stroke care would lead to patient benefits and is the area where ambulance clinicians have the most influence.

Phenomenological study exploring ethics in prehospital research from the paramedic’s perspective: experiences from the Paramedic-2 trial in a UK ambulance service

ObjectivesWe set out to investigate paramedics’ views of ethics and research, drawing on experiences from Paramedic-2, a randomised controlled trial comparing epinephrine and placebo in out-of-hospital cardiac arrest (OHCA).MethodsAn interpretative...

A retrospective review of patients with significant traumatic brain injury transported by emergency medical services within the south east of England

Introduction:Traumatic brain injury (TBI) will be a leading cause of death and disability within the Western world by 2020. Currently, 80% of all TBI patients in England are transported to hospital by an ambulance service. The aim of this retrospective study is to compare TBI patients transported to a major trauma centre (MTC) against those transported to a trauma unit (TU).Method:All patients with a primary injury of TBI who were transported to hospital by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) from 1 January 2016 to 31 December 2016 and entered into the Trauma Audit & Research Network (TARN) registry were reviewed. Patients were stratified by hospital designation (MTC or TU). Severity of TBI was categorised using the patients’ pre-hospital Glasgow Coma Scale (GCS) and Abbreviated Injury Score (AIS) Head. The outcomes of interest were 30-day mortality and Glasgow Outcome Score (GOS) at discharge.Results:Between 1 January and 31 December 2016, 549 TBI patients were identified in the TARN database as being transported by SECAmb to either an MTC or a TU. The majority of patients were transported to a TU (77.96%), and the median age of the TU cohort was older than the MTC group (TU 82.15 IQR 16.73 vs. MTC 62.1 IQR 42.6). The median Injury Severity Score (ISS) was greater in the MTC cohort (22 IQR 10 vs. 17 IQR 9), where falls from height and road traffic collisions (RTCs) contributed to 50.51% of all injuries. Within the TU cohort, falls from less than 2 metres (standing height) were the main mechanism of injury (MOI) (77.62%). The median length of hospital stay (LOS) was longer in the MTC cohort compared to the TU cohort (10 IQR 13.25 vs. 8 IQR 14).Conclusion:The high proportion of mild TBI and absence of reliable triage guidelines make it difficult for ambulance clinicians to identify patients who will benefit from transport to an MTC. Future research should focus on how TBI triage influences outcomes and how ambulance services can better identify patients with a TBI and who would benefit from specialist care.

Ambulance clinicians' perceptions, assessment and management of frailty: thematic analysis of focus groups.

Introduction:More than half of all patients attended by the South Western Ambulance Service NHS Foundation Trust are over the age of 65. In 2017, 62% of older patients who were the subject of a frailty assessment were believed to have at least mild frailty (1/5 of all patients). Frailty is an increasingly relevant concept/diagnosis and ambulance services are well positioned to identify frailty and influence the ‘care pathways’ through which patients are directed (thereby influencing health outcomes). Throughout the South Western Ambulance Service NHS Foundation Trust, a mandatory training session regarding frailty was delivered to clinical personnel in 2017 and frailty assessment tools are available on the electronic Patient Clinical Record.Aim:To explore and gain insight into the current knowledge, practice and attitudes of ambulance clinicians regarding frailty and patients with frailty.Methods:Two focus groups of ambulance clinicians (n = 8; n = 9) recruited from across the South Western Ambulance Service NHS Foundation Trust were held in October 2017. Focus group discussions were analysed thematically.Results:Knowledge of conceptual models of frailty, appropriate assessment of patients with frailty and appropriate care pathways varied substantially among focus group participants. Completion of the ‘Rockwood’ Clinical Frailty Scale for relevant patients has become routine. However, conflicting opinions were expressed regarding the context and purpose of this. The Timed-Up-and-Go mobility assessment tool is also on the electronic Patient Clinical Record, but difficulties regarding its completion were expressed.Patient management strategies ranged from treatment options which the ambulance service can provide, to referrals to primary/community care which can support the management of patients in their homes, and options to refer patients directly to hospital units or specialists with the aim of facilitating appropriate assessment, treatment and discharge. Perceptions of limited availability and geographical variability regarding these referral pathways was a major feature of the discussions, raising questions regarding awareness, capacity, inter-professional relationships and patient choice.Conclusion:Knowledge, practice and attitudes of ambulance staff, with regard to frailty, varied widely. This reflected the emerging nature of the condition, both academically and clinically, within the ambulance profession and the wider healthcare system.

The new Red 1 ambulance response time definition: evaluating clinical impact

Rapid identification of patients with life-threatening conditions is the main priority for any ambulance telephone triage system. Historically there has been a focus on the identification of patients in cardiac arrest; however, the clinical benefits of early recognition of patients in peri-arrest could be considered equally important. An expanded definition of the highest priority response, Red 1, was introduced to identify patients who are critically unwell, at high risk of cardiac arrest, and who would benefit clinically from the fastest level of response from the ambulance service. An evaluation of the impact of the new Red 1 definition was completed in South Western Ambulance Service NHS Foundation Trust during 2013. It demonstrated that the new Red 1 definition was more sensitive than the previous Red 1 definition in identifying patients in cardiac arrest and those at high risk of out-of-hospital cardiac arrest. The total number of patients who required resuscitation decreased by 11.7% under the new Red 1 definition, supporting the hypothesis that more patients are captured by the new Red 1 definition and a more rapid response diminishes their likelihood of experiencing a cardiac arrest.

Coventry University competes in the Student Paramedic International Rally of Emergency Simulations (SPIRES) 2016

Journal of Paramedic PracticeVol. 8, No. 9 Conference ReportCoventry University competes in the Student Paramedic International Rally of Emergency Simulations (SPIRES) 2016Geoffrey Higginbotham, Peter Arbuthnot, Abigail Chen, Jack Cornforth, Amy McDonald, Kate Bushen, John RenshawGeoffrey HigginbothamSearch for more papers by this author, Peter ArbuthnotSearch for more papers by this author, Abigail ChenSearch for more papers by this author, Jack CornforthSearch for more papers by this author, Amy McDonaldSearch for more papers by this author, Kate BushenSearch for more papers by this author, John RenshawSearch for more papers by this authorGeoffrey Higginbotham; Peter Arbuthnot; Abigail Chen; Jack Cornforth; Amy McDonald; Kate Bushen; John RenshawPublished Online:21 Sep 2016https://doi.org/10.12968/jpar.2016.8.9.442AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Eaton G (2016) SPIRES 2016: Oxford Brookes University. www.obu-spires.co.uk/the-event/ (accessed 19 July 2016) Google ScholarFellows B (2016) Follow My Leader [conference presentation]. Student Paramedic International Rally of Emergency Simulations Conference, Oxford Brookes University, Oxford Google ScholarHeffern DJ (2016) Canadian Paramedicine: Past, Present and into the Future [conference presentation]. Student Paramedic International Rally of Emergency Simulations Conference, Oxford Brookes University, Oxford Google ScholarLovegrove M (2016) UK Paramedics Inside Out and Outside In [conference presentation]. Student Paramedic International Rally of Emergency Simulations Conference, Oxford Brookes University, Oxford Google ScholarMcKie P (2016) Paramedic Education Worldwide [conference presentation]. Student Paramedic International Rally of Emergency Simulations Conference, Oxford Brookes University, Oxford Google ScholarPhilips A (2016) Paramedics Take on GP Practice: The Answer to Today's Primary Care Problems. [conference presentation]. Student Paramedic International Rally of Emergency Simulations Conference, Oxford Brookes University, Oxford Google ScholarSibson L (2016) Writing for Publication [conference workshop]. Student Paramedic International Rally of Emergency Simulations Conference, Oxford Brookes University, Oxford Google ScholarSouth Central Ambulance Service NHS Foundation Trust (2016) Board of Directors: Medical Director. www.scas.nhs.uk/about-scas/our-board/board-of-directors/dr-john-black/ (accessed 19 July 2016) Google Scholar FiguresReferencesRelatedDetails 2 September 2016Volume 8Issue 9ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 21 September 2016 Published in print 2 September 2016 Information© MA Healthcare LimitedAcknowledgementsThe authors would like to extend our gratitude to Georgette Eaton and the Paramedic Team at Oxford Brookes University for organising such a fantastic event, and thank the sponsors for their support. Finally, the authors would like to thank Coventry University for their financial assistance, support and encouragement in this venture.PDF download

Variation in ambulance call rates for care homes in Torbay, UK.

Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1 April 2012 and 31 July 2013. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21-0.89; 0.03-2.45). Nursing homes had a lower call rate than residential homes [adjusted rate ratio (ARR) 0.29; 95% CI: 0.22-0.40; P<0.001]; care homes failing the quality and suitability of management standard had a lower call rate compared to those who passed (ARR 0.67; 95% CI: 0.50-0.90; P=0.006); and homes specialising in dementia had a higher call rate compared to those not specialising (ARR 1.56; 95% CI: 1.23-1.96; P<0.001). These findings require replication in other regions to establish their generalisability and further investigation is required to determine the extent to which call rate variability reflects the different needs of resident populations or differences in care home policies and practice.

Which factors most influence demand for ambulances in South West England?

Ambulance demand in South West England is increasing year-on-year, but the driving forces behind such increases are poorly understood. We developed a system dynamics model to simulate the factors that influence a call being made for an ambulance. We used data from the South West Ambulance Service NHS Foundation Trust (SWAST), the Office of National Statistics (ONS) and quantitative relationship data in both national and international literature to parameterise the model. We compared predicted ambulance demand over 12 months in the base case model with scenarios in which each influencing factor was removed in turn. The model predicts that the prevalence of regular falls among older people most influences the level of demand for ambulances. The model also predicts that the number of users of adult mental health services could be a significant contributor to ambulance demand. Additional focus on, and investment in, falls prevention strategies could help to significantly alleviate increasing levels of demand for ambulance services in South West England. Additionally, efforts to understand why those with mental health needs tend to use ambulances more than those without such needs could also be beneficial.

An exploration of the views of paramedics regarding airway management.

BackgroundParamedics are a skilled group of clinicians with expertise in airway management. Our research group has completed a trial comparing supraglottic airway devices with tracheal intubation during out of hospital cardiac arrest. This is a contentious topic amongst paramedics in the United Kingdom (UK). We explored the customs and beliefs of UK paramedics in relation to airway management, and whether tracheal intubation contributes to and sustains paramedic professional identity.MethodsThe study took place within South Western Ambulance Service NHS Foundation Trust. We used a qualitative approach, conducting interviews and focus groups with paramedics. The themes arising from interviews were discussed in focus groups, developing a deeper understanding and providing insight and recommendations for future research and policy. Purposive sampling accounted for differing training and for participation in the main trial. There were 17interviews and five focus groups with a further 17 participants. Data saturation was achieved.ResultsFour domains were identified. Pride - The ability to use a life-saving skill in austere conditions. Utility - Different training routes and experience have led to different attitudes towards airway management. Inconsistent expectations - Paramedics felt that there were different perceptions of their abilities amongst hospital staff and the general public. Professionalization - Debate over airway management is not founded on good evidence.ConclusionWe have demonstrated that UK paramedics have a wide range of views regarding airway management, and that these are based on evidence and experience rather than dogma. Airway management contributes to paramedics’ professional identity, but is not reliant on this.