Yorkshire Ambulance Service Research Articles

Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study

ObjectiveTo assess accuracy of telephone triage in identifying need for emergency care among those with suspected COVID-19 infection and identify factors which affect triage accuracy.DesignObservational cohort study.SettingCommunity telephone triage provided...

Exploring spatial patterns of vulnerability using linked health data

Introduction & BackgroundThe types of challenges police and ambulance services deal with often overlap, for instance supporting those who suffer from mental ill-health. Research has shown that emergency service problems often concentrate, but also that some individuals who come to the attention of one service may not be as visible to another despite their overlap in roles.
 Objectives & ApproachThis study explored how routinely collected 999 data may reveal insights into how these services support potentially vulnerable populations. We argue that better understanding the nature and distribution of vulnerability-related calls may help to inform future preventative or harm reduction-based interventions. We analysed administrative data provided by Yorkshire Ambulance Service for the Bradford region through the Connected Bradford research database, posing the following questions: (1) can 999 call data provide insights into vulnerability-related incidents attended by ambulances?; (2) where and when are these incidents most prevalent?; and (3) what are the spatial patterns of calls and patient home locations associated with them?
 Relevance to Digital FootprintsWe first select calls associated with nine callout reasons indicative of vulnerability. Patients can choose to share their data with each healthcare service they use, so we harnessed this digital footprint to analyse the spatial distribution of call locations (at postcode sector level) and patient home location (at MSOA level).
 ResultsResults indicate substantial concentrations of vulnerability-related calls in multiple postcode sectors including the City Centre (where we estimate 18% of calls may be vulnerability-related) and several other areas which are associated with deprivation. Exploring flows of people from their home location to incident location we also see substantial spatial variation in the locations in which patients involved in these types of incidents reside.
 Conclusions & ImplicationsThese analyses represent initial efforts to better understand how vulnerable groups are supported by public services, and have the potential to inform future resource allocation and targeting of upstream interventions.

What insights can ambulance data provide on vulnerable groups?

Linking administrative data from Yorkshire Ambulance Service with primary health care data, this research project aims to answer the question, “What can YAS data tell us about how vulnerable populations interact with the service in Bradford?”
 We selected 9 primary callout reasons as recorded in the data that could be vulnerability-related, and explored patterns of these both spatially and temporally, with comparison to all other callout reasons. The data also includes a pseudonymised NHS number which allows linkage with other datasets for which the patient has shared this identifier. In this case, we took their home LSOA to create a rudimentary gravity model visualising flows of people from their home location to their ambulance incident location.
 Key findings include that vulnerability-related callouts were more frequent in the evenings and overnight on weekends, and concentrated on specific areas, both in terms of where incidents occur and areas from which callers originate. In terms of the individuals behind the calls, we found that while callers from both subsets were more likely to be female, the average age of callers for vulnerability-related incidents was almost 20 years younger than callers for all other reasons. Additionally, we discovered which callout reasons were most likely to see individuals requiring an ambulance multiple times.
 This research provides valuable policy-relevant insights into emergency service demand relating to vulnerable populations in the Bradford region, highlighting the importance of understanding the needs of vulnerable populations to ensure that emergency services are allocated effectively and efficiently.

Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study

BackgroundAmbulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify...

Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow testing and direct admissions pathway: exploring why well-received ideas have low uptake.

In January 2021, Yorkshire Ambulance Service and Hull University Teaching Hospitals implemented a pilot COVID-19 lateral flow testing (LFT) and direct admissions pathway to assess the feasibility of using pre-hospital LFTs to bypass the emergency department. Due to lower than anticipated uptake of the pilot among paramedics, we undertook a process evaluation to assess reasons for low uptake and perceived potential benefits and risks associated with the pilot. We undertook semi-structured telephone interviews with 12 paramedics and hospital staff. We aimed to interview paramedics who had taken part in the pilot, those who had received the project information but not taken part and ward staff receiving patients from the pilot. We transcribed interviews verbatim and analysed data using thematic analysis. Participation in the pilot appeared to be positively influenced by high personal capacity for undertaking research (being 'research-keen') and negatively influenced by 'COVID-19 exhaustion', electronic information overload and lack of time for training. Barriers to use of the pathway related to 'poor timing' of the pilot, restrictive patient eligibility and inclusion criteria. The rapid rollout meant that paramedics had limited knowledge or awareness of the pilot, and pilot participants reported poor understanding of the pilot criteria or the rationale for the criteria. Participants who were involved in the pilot were overwhelmingly positive about the intervention, which they perceived as having limited risks and high potential benefits to the health service, patients and themselves, and supported future roll-out. Ambulance clinician involvement in rapid research pilots may be improved by using multiple recruitment methods (electronic and other), providing protected time for training and increased direct support for paramedics with lower personal capacity for research. Improved communication (including face-to-face approaches) may help understanding of eligibility criteria and increase appropriate recruitment.

Creating virtual communities of practice for ambulance paramedics: a qualitative evaluation of the use of Project ECHO in end-of-life care.

Ambulance services play a key role in the recognition and care of patients nearing their end of life, yet are expected to recognise and manage these complex presentations often with limited education. Paramedics operate across large geographical areas, meaning education delivery is challenging. Yorkshire Ambulance Service implemented Project Extension for Community Healthcare Outcomes (ECHO), which is the creation of virtual communities of practice to address this problem and increase access to specialist supervision, education and sharing of practice. We undertook a service evaluation of the programme and interviewed paramedics about their experiences with ECHO. Semi-structured interviews were conducted with eight ambulance clinicians who took part in the end-of-life care (EoLC) ECHO programme. Thematic analysis and coding was undertaken to identify and develop the emerging themes. This study identified three key themes: programme structure, factors influencing engagement and professional impact. The provision of a virtual community of practice through Project ECHO was a unique and highly valued experience, which was accessible and allowed for networking, peer support and sharing of practice. The concept of a ripple effect was reported in disseminating learning across the wider team. The development of virtual communities of practice as a novel educational intervention has the potential to transform clinical supervision and ongoing education for ambulance clinicians who are often isolated by the nature of ambulance services that cover large regions.

A qualitative analysis of stressors affecting 999 ambulance call handlers' mental health and well-being

PurposeThe 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.Design/methodology/approachA single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.FindingsIn total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.Originality/valueThis paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.

Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: An observational cohort study linking NHS 111 telephone triage, primary and secondary healthcare and mortality records.

ObjectivesSettings in identifying need for emergency care amongst those with suspected COVID-19 infection and identify factors which affect triage accuracy. ApproachAn observational cohort study of adults who contacted the NHS 111 telephone triage service provided by Yorkshire Ambulance Service between March and June 2020 with symptoms indicating possible COVID-19 infection. Patient-level data encompassing triage call, primary care, hospital care and death registration records relating to 40,261 adults were linked. The accuracy of triage outcome (self-care/non-urgent assessment versus ambulance/urgent assessment) was assessed for death or organ support 30 days from first contact. Multivariable logistic regression was used to identify factors associated with risk of false negative or false positive triage. ResultsCallers had a 3% (1,200/40,261) risk of serious adverse outcomes. Telephone triage recommended self-care or non-urgent assessment for 60% (24,335/40,261), with a 1.3% (310/24,335) risk of adverse outcomes 30 days from first contact. Telephone triage had 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (61% to 62%) for the primary outcome. Analysis suggested respiratory comorbidities may be over-appreciated and diabetes under-appreciated as predictors of deterioration. Repeat contact with triage service appears to be an important under-recognised predictor of deterioration. ConclusionPatients advised to self-care or receive non-urgent clinical assessment had a small but non-negligible risk of serious clinical deterioration. Repeat contact with telephone services needs recognition as an important predictor of subsequent adverse outcomes.

The effect of a specialist paramedic primary care rotation on appropriate non-conveyance decisions (SPRAINED) study: a controlled interrupted time series analysis.

NHS ambulance service non-conveyance rates in the United Kingdom are around 30%, despite an increase in non-emergency cases and a national policy of integrating urgent and emergency care to provide patients with the 'right care, in the right place, at the right time'. Emergency department overcrowding is a significant issue for patients, resulting in poorer quality of care, increased healthcare costs and potentially, increased mortality. It also contributes to increased ambulance turnaround times. Yorkshire Ambulance Service NHS Trust (YAS) introduced a specialist paramedic (SP) to improve the management of lower acuity cases, but non-conveyance rates in this group have not been as high as expected.In 2018, Health Education England funded a pilot scheme to rotate paramedics into a range of healthcare settings and in YAS, 10 SPs undertook a 10-week placement in a GP practice. This study aimed to evaluate whether a primary care placement appropriately increased the level and trend of non-conveyance decisions made by SPs following a 10-week GP placement, in a cost-effective manner. We conducted a controlled interrupted time series analysis using data from incidents between 1 June 2017 and 31 December 2019, to study appropriate non-conveyance rates before and after a GP placement. A costing analysis, examining the average cost per appropriate non-conveyance achieved for patients receiving care from intervention group SPs pre- and post-placement, was also conducted. A total of 7349 incidents attended by intervention group SPs were eligible for inclusion. Following removal of cases with missing data, 5537 (75.3%) cases remained. Post-placement, the intervention group demonstrated an increase in appropriate non-conveyance rate of 35.0% (95% CI 23.8%-46.2%), and a reduction in the trend of appropriate non-conveyance of -1.2% (95% CI -2.8%-0.5%), relative to the control group.Post-placement, the cost per appropriate non-conveyance for intervention group SPs was a mean of £509.41 (95% bootstrapped CI £454.92-£564.26) versus £1257.81 (95% bootstrapped CI £1233.42-£1283.95) for the same group in the pre-placement phase. In this single UK NHS ambulance service study, we found a clinically important and statistically significant increase in appropriate non-conveyance rates by SPs who had completed a 10-week GP placement. This improvement persisted for the 12-month period following the placement and demonstrated cost savings compared to usual care.

Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study

ObjectiveTo assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy.DesignObservational cohort study.SettingEmergency telephone triage provided...

Homelessness in the aftermath of COVID-19

Journal of Paramedic PracticeVol. 13, No. 11 CommentHomelessness in the aftermath of COVID-19Philippa Jane NilsenPhilippa Jane NilsenEmail: E-mail Address: [email protected]Newly Qualified Paramedic, Yorkshire Ambulance Service NHS Trust, UKSearch for more papers by this authorPhilippa Jane NilsenPublished Online:9 Nov 2021https://doi.org/10.12968/jpar.2021.13.11.456AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bramley G. Homelessness projections: Core homelessness in Great Britain, London: Crisis; 2017 Google ScholarDavies A, Wood LJ. Homeless health care: meeting the challenges of providing primay care. M J Australia. 2018; 209(5):230–234 Crossref, Google ScholarDepartment of Health and Social Care. Healthcare for single homeless people. 2010. https://tinyurl.com/55sexxpb (accessed 28 October 2021) Google ScholarFazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLOS Med. 2008; 5(12):225 Crossref, Google ScholarFazel S, Geddes J, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014; 384(9953):1529–1540 Crossref, Google ScholarFitzpatrick S, Watts BE, Pawson H, Bramley G, Wood J, Stephens M. The homeless monitor: England 2021. London: Crisis; 2021. https://doi.org/10.13140/RG.2.2.25028.35209 Google ScholarFord S. Warning of major rise in number of homeless people visiting A&E. 2019. https://tinyurl.com/4zpnd38j (accessed 28 October 2021) Google ScholarGov.UK. Coronavirus job retention scheme official statistics: December 2020. 2020. https://tinyurl.com/8usw6ue4 (accessed 28 October 2021) Google ScholarHaber GM, Toro PA. Homelessness among families, children, and adolescents: an ecological-developmental perspective. Clin Child Fam Psychol Rev. 2004; 7(3):123–164 Crossref, Google ScholarHabitat for Humanity. Slum rehabilitation. 2015. https://tinyurl.com/35rwvban (accessed 28 October 2021) Google ScholarHeriot Watt University. Homelessness projections: Core homelessness in Great Britain. London: Crisis; 2017 Google ScholarHousing Rights. What causes homelessness and rough sleeping? 2019. https://tinyurl.com/3295pd6e (accessed 28 October 2021) Google ScholarJohnsen S, Watts B. Homelessness and poverty: reviewing the links. 2014. https://pure.hw.ac.uk/ws/portalfiles/portal/6831437/ENHRfullpaper_H_P.pdf (accessed 29 October 2021) Google ScholarJones CA, Perera A, Chow M, Ho I, Nguyen J, Davachi S. Cardiovascular disease risk among the poor and homeless - what we know so far. Curr Cardiovasc Rev. 2009; 5(1):69–77. https://doi.org/10.2174/157340309787048086 Crossref, Google ScholarKim DH, Daskalakis C, Plumb JD al. Modifiable cardiovascular risk factors among individuals in low socioeconomic communities and homeless shelters. Fam Comm Health. 2008; 31(4):269–280 Crossref, Google ScholarLacobucci G. Homeless people's A&E visits treble in seven years. Br Med J. 2019; 364(1323) Google ScholarLeng G. The impact of homelessness on health, London: Local Government Association; 2017 Google ScholarMinistry of Housing, Communities and Local Government. Homelessness code of guidance for local authorities. 2018. https://tinyurl.com/4n6hbwm4 (accessed 28 October 2021) Google ScholarMinistry of Housing Communities and Local Government. Homelessness: applying All Our Health. 2019. https://tinyurl.com/ytmknspf (accessed 28 October 2021) Google ScholarMinistry of Housing Communities and Local Government. Statutory Homelessness: October to December (Q4) 2020: England. 2021. https://tinyurl.com/4sc3t2t7 (accessed 28 October 2021) Google ScholarOffice for National Statistics. Deaths of homeless people in England and Wales: 2019 registrations. 2020. https://tinyurl.com/4ceej6wx (accessed 28 October 2021) Google ScholarOrganisation for Economic Co-operation and Development. Affordable Housing Database: Housing Population. 2020. https://tinyurl.com/vvcnvzht (accessed 28 October 2021) Google ScholarTang S, Dovey G, Mapstone J. Homelessness: implications for paramedic practice. J Para Pract. 2019; 11(2):52–53. https://doi.org/10.12968/jpar.2019.11.2.52 Link, Google ScholarThe Lancet. Housing and homelessness as a health crisis. Lancet. 2019;394(10205):1206. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32267-6/fulltext (accessed 29 October 2021) Google Scholar FiguresReferencesRelatedDetails 2 November 2021Volume 13Issue 11ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 9 November 2021 Published in print 2 November 2021 Information© MA Healthcare LimitedPDF download

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

Background/aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

The acceptability and safety of video triage for ambulance service patients and clinicians during the COVID-19 pandemic.

Introduction:In response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust introduced video technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the EOC. We conducted a service evaluation with the aim of investigating patient and staff acceptability of video triage, and the safety of the decision-making process.Methods:This service evaluation utilised a mixture of routine and bespoke data collection. We sent postal surveys to patients who were recipients of a video triage, and clinicians who were involved in the video triage pilot logged calls they attempted and undertook.Results:Between 27 March and 25 August 2020, clinicians documented 1073 triage calls. A successful video triage call was achieved in 641 (59.7%) cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) were also satisfied with the technology and with the care they received. Callers receiving video triage that ended with a disposition of ‘hear and treat’ had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical hub telephone triage alone (16/212, 7.5% vs. 2508/14349, 17.5% respectively).Conclusion:In this single NHS Ambulance Trust evaluation, the use of video triage for low-acuity calls appeared to be safe, with low rates of re-contact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate for or acceptable to patients and technical issues were not uncommon.

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

Background/Aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

Impact of community initiatives on non-EMS bystander CPR rates in West Yorkshire between 2014 and 2018

AimBystander CPR rates have steadily increased in England between 2014 and 2018. In West Yorkshire, there have been two important developments during this time. We aimed to describe whether postcode districts (PCDs) with more cumulative annual ‘Restart a Heart’ (RSAH) and/or Community First Responder (CFR) scheme activity between 2014 and 2018 were associated with greater improvements in non-EMS bystander CPR rates for out-of-hospital cardiac arrest (OHCA) when compared with PCDs in the same region with lesser or no such historic activity during the same time period. MethodWe collated data from the OHCA Outcomes Registry for all non-EMS witnessed OHCA in West Yorkshire treated by Yorkshire Ambulance Service. We analysed clusters of PCDs with high and low levels of RSAH and CFR activity between 2014 and 2018 using descriptive statistics, and comparisons were made between groups using chi-square and t-test. ResultsThe reported bystander CPR rate for non-EMS witnessed OHCA cases for West Yorkshire rose from 38.4% in 2014 to 69.7% in 2018. The largest increases were seen in PCDs with high RSAH activity (+34.3%) and in the combination of high RSAH and low CFR activity (+38.5%). There was no significant difference when considering the interaction between RSAH and CFR groups. ConclusionThe data infers the possibility of a non-significant association between improved non-EMS bystander CPR rates and RSAH training and CFR scheme activity. We recommend coordinated mass training, in particular for children in regions where CPR is not a mandatory part of the school curriculum.

A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

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). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology.Methods:All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data.Results:478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%).Conclusion:Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival.

Soiled Airway Tracheal Intubation and the Effectiveness of Decontamination by United Kingdom Paramedics (Satiated2): A Randomised Controlled Manikin Study

Introduction Vomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest, but traditional paramedic suctioning techniques may be insufficient to manage severely soiled airways. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed to help clinicians manage soiled airways. SATIATED2 reports the impact of SALAD training in North East Ambulance Service (NEAS) in the United Kingdom following the original SATIATED study in the Yorkshire Ambulance Service. The primary research question was: Among NEAS paramedics, does the addition of SALAD training, compared to standard training, improve the success rate of intubation for the soiled airway? Methods A randomised controlled trial of SALAD was conducted using a modified airway manikin capable of vomiting. The intervention comprised SALAD training and the introduction of the DuCanto catheter. Paramedic volunteers were block randomised into two groups: A01A02B01 who made two pre-training intubation attempts and one post-training attempt, and A11B11B12, who made one pre-training and two post-training attempts. The primary outcome was intubation success rate at the second attempt. The time taken to intubate was recorded as a secondary outcome. SATIATED2 was registered with ISRCTN (ISRCTN17329526) and funded internally with commercial support from SSCOR who supplied the DuCanto catheters. Results One-hundred and two paramedics (51 AAB, 51 ABB) were recruited between August and December 2019 with 99 participating (50 AAB, 49 ABB). The primary outcome was intubation success rate on the second attempt (A02 vs. B11) which were 86% without SALAD and 96% with SALAD; a non-significant improvement of 10% (95% CI: 1–21, p=0.09). The total intubation success rate pre-training (A01+A02+A11) was 75% (112/149) compared with 98% (145/148) post-training (B01+B11+B12). Conclusion NEAS paramedics demonstrated improved, but non-significant, intubation success rates in a simulated soiled airway following SALAD training.

Do RATs save lives? A service evaluation of an out-of-hospital cardiac arrest team in an English ambulance service.

Introduction:Out-of-hospital cardiac arrest (OHCA) is a major public health problem, leading to a substantial number of deaths in the UK. In response to this, the Yorkshire Ambulance Service NHS Trust (YAS) has introduced red arrest teams (RATs). RAT members attend a three-day training course, focusing on the technical and non-technical skills that are required to effectively team lead an OHCA and provide high quality post-resuscitation care. This evaluation aims to determine the impact of the RATs on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.Methods:All adult (≥ 18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between 1 October 2015 and 30 September 2017 were included if the patient was resuscitated and the cause of the arrest was considered to be medical in origin. Multi-variable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.Results:During the 2-year data collection period, YAS attended 15,151 cardiac arrests. After removing ineligible cases, 5868 cardiac arrests remained. RATs attended 2000/5868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, min. 1, max. 78).The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95% CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95% CI 0.99–1.29), compared to the odds of not having a RAT present, although neither result is statistically significant.Conclusion:The presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA.

The impact of an ambulance vehicle preparation service on the presence of bacteria: a service evaluation.

Introduction:Around 300,000 patients a year in England acquire a healthcare-associated infection (HAI) while being cared for by the NHS. The contribution from NHS Ambulance Services is not known, but previous studies have identified the presence of pathogenic bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus, including resistant strains in some cases, inside ambulances. To improve ambulance cleanliness, Yorkshire Ambulance Service NHS Trust (YAS) piloted an Ambulance Vehicle Preparation Service (AVPS) at two ambulance stations, where staff were tasked with ensuring every ambulance at these stations was cleaned every 24 hours.Methods:Adenosine triphosphate (ATP) bioluminescence testing was conducted on 16 ambulances at the two pilot AVPS stations and on 18 ambulances at four ‘business as usual’ (BAU) ambulance stations using a Hygiena SystemSURE luminometer. Swabs were obtained from 10 pre-selected locations inside each ambulance.Results:Between November 2016 and August 2018, a total of 690 swabs were obtained and recorded from 34 ambulances. Overall, median relative light unit (RLU) values for both groups were < 100, with only the BAU group having an upper quartile value > 100. However, when stratified by swabbing area, three areas had a median RLU of > 100 in the BAU group: suction unit handle, steering wheel and airway seat shelf. In addition, the upper quartile RLU values for the grab rail above the stretcher and the passenger seat in the BAU group were also > 100. No swab areas had a median RLU > 100 in the AVPS group.Conclusion:A dedicated AVPS results in better cleaning of ambulance vehicles than the existing cleaning system utilising operational crews. The areas most likely to be contaminated are the suction unit handle, steering wheel, airway seat shelf and grab rails. The position of equipment and the materials that equipment are constructed from should have infection prevention and control (IPC) as a consideration.

Do RATs save lives? A retrospective analysis of out-of-hospital cardiac arrest in an English Ambulance Service

&lt;h3&gt;Study aim&lt;/h3&gt;&lt;p&gt;This study aims to determine the impact of the red arrest teams (RATs) on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p class="FirstParagraph"&gt;A retrospective cohort study analysing routinely collected data was undertaken. All adult (≥18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between the 1st October, 2015 and 30th September, 2017 were included if the patient was resuscitated, and the cause of the arrest was considered to be medical in origin. Multivariable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;During the 2-year data collection period, 15,151 cardiac arrests that were attended by Yorkshire Ambulance Service. After removing ineligible cases, 5,868 cardiac arrests remained. RATs attended 2,000/5,868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, minimum 1, maximum 78).&lt;/p&gt;&lt;p class="FirstParagraph"&gt;The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95%CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95%CI 0.99–1.29), compared to the odds of not having a RAT present, although neither results are statistically significant.&lt;/p&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p class="FirstParagraph"&gt;The presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA&lt;/p&gt;