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Ambulance, paramedic, nhs

Assaf Givati, Chris Markham, Ken Street
Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals' education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal-political circumstances affecting its provision and demand...
May 2018: Advances in Health Sciences Education: Theory and Practice
Helen A Snooks, Rebecca Anthony, Robin Chatters, Jeremy Dale, Rachael Fothergill, Sarah Gaze, Mary Halter, Ioan Humphreys, Marina Koniotou, Phillipa Logan, Ronan Lyons, Suzanne Mason, Jon Nicholl, Julie Peconi, Ceri Phillips, Judith Phillips, Alison Porter, A Niroshan Siriwardena, Graham Smith, Alun Toghill, Mushtaq Wani, Alan Watkins, Richard Whitfield, Lynsey Wilson, Ian T Russell
BACKGROUND: Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. OBJECTIVES: To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use...
March 2017: Health Technology Assessment: HTA
S Voss, S Black, J Brandling, M Buswell, R Cheston, S Cullum, K Kirby, S Purdy, C Solway, H Taylor, J Benger
INTRODUCTION: Older people with multimorbidities frequently access 999 ambulance services. When multimorbidities include dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased, even when a condition is treatable in the community. People with dementia tend to do poorly in the acute hospital setting and hospital admission can result in adverse outcomes. This study aims to provide an evidence-based understanding of how older people living with dementia and other multimorbidities are using emergency ambulance services...
April 3, 2017: BMJ Open
Adam J Noble, Darlene Snape, Steve Goodacre, Mike Jackson, Frances C Sherratt, Mike Pearson, Anthony Marson
OBJECTIVES: The UK ambulance service is expected to now manage more patients in the community and avoid unnecessary transportations to hospital emergency departments (ED). Most people it attends who have experienced seizures have established epilepsy, have experienced uncomplicated seizures and so do not require the full facilities of an ED. Despite this, most are transported there. To understand why, we explored paramedics' experiences of managing seizures. DESIGN AND SETTING: Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service...
November 9, 2016: BMJ Open
Maxine Johnson, Rachel O'Hara, Enid Hirst, Andrew Weyman, Janette Turner, Suzanne Mason, Tom Quinn, Jane Shewan, A Niroshan Siriwardena
BACKGROUND: Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context...
January 24, 2017: BMC Medical Research Methodology
Frances C Sherratt, Darlene Snape, Steve Goodacre, Mike Jackson, Mike Pearson, Anthony G Marson, Adam J Noble
INTRODUCTION: The UK ambulance service often attends to suspected seizures. Most persons attended to will not require the facilities of a hospital emergency department (ED) and so should be managed at scene or by using alternative care pathways. Most though are transported to ED. One factor that helps explain this is paramedics can have low confidence in managing seizures. OBJECTIVES: With a view to ultimately developing additional seizure management training for practicing paramedics, we explored their learning needs, delivery preferences and potential drivers and barriers to uptake and effectiveness...
January 9, 2017: BMJ Open
Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
Georgina Murphy-Jones, Stephen Timmons
INTRODUCTION: For a patient nearing the end of his or her life, transfer from a nursing home to the ED can be inappropriate, with potentially negative consequences, but transfer in these circumstances is, regrettably, all too common. There is a lack of published literature exploring how paramedics make decisions in end-of-life care situations. This study aims to explore how paramedics make decisions when asked to transport nursing home residents nearing the end of their lives. METHODS: Phenomenological influenced design with a pragmatic approach...
October 2016: Emergency Medicine Journal: EMJ
Janet Brandling, Megan Rhys, Matthew Thomas, Sarah Voss, Sian Emma Davies, Jonathan Benger
BACKGROUND: Paramedics 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...
April 27, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Mohammad Iqbal, P Anne Spaight, Ros Kane, Zahid Asghar, A Niroshan Siriwardena
BACKGROUND: Pain affects 4 out of 5 patients presenting to ambulance services and is often poorly assessed and treated. Currently, patients' pain is assessed by ambulance clinicians using a numerical verbal (zero to ten) pain score (NVPS). Our previous qualitative study showed that NVPS were poorly understood by patients and that a better pain assessment tool was needed. This current study sought to develop and test a novel pain assessment tool 'Patient Reported Outcome Measure for Pain Treatment (PROMPT)' for feasibility of use by ambulance paramedics...
June 2015: Emergency Medicine Journal: EMJ
Leila Bassir, Linda Dykes, Rob Perry
INTRODUCTION: We noticed that COPD patients travelling long distances to our rural ED arrived in a worse condition than those living nearby. We suspected this might be due to oxygen-driven nebulisers en route: high-flow oxygen during transfer is known to increase COPD mortality. METHODS: We conducted a retrospective chart review of ED patients who arrived by ambulance and were admitted with exacerbations of COPD December 2010-March 2011. ▸ 42/114 lacked ambulance records, leaving 72 cases for analysis...
May 2015: Emergency Medicine Journal: EMJ
Leo McCann, Edward Granter, John Hassard, Paula Hyde
The paramedic profession, along with the broader structure and mission of NHS emergency ambulance provision, is undergoing significant but rather undefined change. The clinical scope of the paramedic role has broadened, and the opening of new patient pathways has enabled a broader range of treatment and referral options for attending ambulance crews. Ambulance trusts have moved to an all-graduate intake for new paramedics, and significant advances have been made in establishing the classic steps of a 'professionalization project' (such as the growth of the College of Paramedics, the development of peer-reviewed practitioner journals, and the introduction of advanced paramedic roles...
May 2015: Emergency Medicine Journal: EMJ
Robin Chatters, Helen Snooks, Sarah Gaze, Marina Koniotou
BACKGROUND: The SAFER 2 study is an RCT looking to improve the care provided by ambulance service to elderly patients who fall, by providing paramedics with a complex intervention consisting of a paramedic training programme, referral pathway to Falls Prevention Services, clinical support, a clinical decision flowchart and referral feedback. The study received confirmation of funding in December 2008; originally, patient recruitment was scheduled to finish in December 2011. METHODS: Information regarding the progress of the study was sought from study staff, study timelines and quarterly reports sent to the study funders (HTA)...
May 2015: Emergency Medicine Journal: EMJ
Richard Walker, Sarah Black
In 2004 The National Institute for Health and Care Excellence (NICE) recommended in that ambulance services should carry Single Dose Activated Charcoal (SDAC) as an antidote to self-poisoning. A survey of ambulance services conducted a year later found a strong reluctance by services to carry the medication. As a result of a research project supporting the recommendation of NICE the South Western Ambulance Service conducted a six month trial of SDAC in two of its zones. A Patient Group Directive was produced and an education programme put in place...
May 2015: Emergency Medicine Journal: EMJ
Mary Halter, Robin Chatters, Marina Koniotou, Bridie Evans
BACKGROUND: Older people who fall have been a priority area for the NHS since the publication of the National Service Framework for Older People. Evidence suggests falls prevention can reduce further falls. With rising numbers using Emergency Departments, there is a policy shift for ambulances to convey fewer patients and efforts to refer falls patients to other services OBJECTIVE: To review evidence about impact and implementation of interventions delivered by emergency medical services to treat older people who fall to reduce emergency admissions to hospital...
May 2015: Emergency Medicine Journal: EMJ
Rachel O'Hara, Maxine Johnson, A Niroshan Siriwardena, Andrew Weyman, Janette Turner, Deborah Shaw, Peter Mortimer, Chris Newman, Enid Hirst, Matthew Storey, Suzanne Mason, Tom Quinn, Jane Shewan
OBJECTIVES: Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors...
January 2015: Journal of Health Services Research & Policy
Johannes von Vopelius-Feldt, Jonathan Benger
Critical care paramedics (CCPs) have been introduced by individual ambulance trusts in England, but there is a lack of national coordination of training and practice. We conducted an online survey of NHS ambulance services to provide an overview of the current utilization and role of CCPs in England. The survey found significant variations in training, competencies and the working patterns of the ∼90 CCPs working in five ambulance services. All ambulance trusts currently employing CCPs are planning on increasing CCP numbers, whereas 'insufficient financial means' and 'insufficient scientific evidence' are the two major barriers to CCP utilization...
August 2014: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Jason Killens
LOCOG Medical managed thousands of patient contacts across all the Games venues without our intervention. A polyclinic in the athlete's village had extensive diagnostic options, including X-ray and magnetic resonance imaging for athletes and the Olympic family. These helped limit the number of patients who needed transport to the ED. Although the delivery was seamless, there were "behind the scenes" moments in the final stages of planning that made us think. We received additional requests for ambulance cover at training venues that hadn't been planned for on short notice...
March 2013: JEMS: a Journal of Emergency Medical Services
Helen Snooks, Rebecca Anthony, Robin Chatters, Wai-Yee Cheung, Jeremy Dale, Rachael Donohoe, Sarah Gaze, Mary Halter, Marina Koniotou, Phillippa Logan, Ronan Lyons, Suzanne Mason, Jon Nicholl, Ceri Phillips, Judith Phillips, Ian Russell, A Niroshan Siriwardena, Mushtaq Wani, Alan Watkins, Richard Whitfield, Lynsey Wilson
INTRODUCTION: Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services...
2012: BMJ Open
Johannes von Vopelius-Feldt, Jonathan R Benger
OBJECTIVES: Prehospital anaesthesia using rapid sequence induction (RSI) is carried out internationally and in the UK despite equivocal evidence of clinical benefit. It is a core skill of the prehospital critical care service established by the Great Western Ambulance Service NHS Trust (GWAS) in 2008. This retrospective analysis of the service's first 150 prehospital RSIs describes intubation success rates and complications, thereby contributing towards the ongoing debate on its role and safety...
December 2013: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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