Ambulance Research Repository (AMBER)
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Esmolol in persistent ventricular fibrillation/tachycardia with de-emphasised adrenaline - Introducing the REVIVE project
No full textSafety and efficacy of paramedic treatment of regular supraveentricular tachycardia
No full textIntroduction Treatment of supraventricular tachycardia (SVT) with adenosine by paramedics has been investigated and proven to be safe in the USA, but patients (pts) are transferred to hospital. We hypothesised that paramedics can safely treat and discharge pts with regular SVT without transfer to an accident and emergency department and tested this in a randomised controlled trial. Methods Pts presenting with regular narrow complex tachycardia on 12 lead ECG who were heamodynamically stable, with no history of structural or ischaemic heart disease and without contraindication to adenosine were considered for enrolment. Pts were randomised to paramedic treatment (PARA) or admission to hospital (A&E). PARA pts received valsalva manoeuvre at the scene with subsequent administration of 6 mg and 12 mg of adenosine unless the SVT terminated. Pts were taken to A&E if the tachycardia did not terminate, restarted, or the patient (pt) had continuing symptoms, a persistently abnormal ECG (other than Twave inversion) or was heamodynamically unstable. Prior to discharge from the ambulance pts received an information pack and a referral letter for their GP to refer them to an arrhythmia clinic. Pts randomised to A&E were treated as normal and given no information other than that pertaining to the study. Results Of the 60 pts (33=F, age 52+/-19 years) enroled to date, 56% pts had previously attended A&E with palpitations. 2 pts withdrawn as lost to follow up. Results table 1 PARA discharge times were relatively long because 12 pts randomised to PARA were transported to A&E (5 did not terminate arrhythmia, 1 abnormal observations, 4 paramedic felt ECG abnormal (confirmed as minor abnormalitites by expert panel that would not require treatment), 2 abnormal ECG requiring treatment). A panel of 2 arrhythmia experts reviewed records for all PARA pts and confirmed treatment was appropriate for all but would have further assessed 1 pt with lung disease. Conclusions Paramedic treatment and discharge of pts with regular SVT is safe, efficacious and reduces admissions. Cost effectiveness analysis is ongoing. http://heart.bmj.com/content/99/suppl_2/A46.1.full.pdf+html?sid=0fb7e2f8-0ace-45ee-ba38-57a2777d5d31 https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed14&AN=71283783 https://libkey.io/libraries/2901/openurl?genre=article&sid=OVID:embase&id=pmid:&id=doi:10.1136%2Fheartjnl-2013-304019.71&issn=1355-6037&isbn=&volume=99&issue=SUPPL.+2&spage=A46&pages=A46&date=2013&title=Heart&atitle=Safety+and+efficacy+of+paramedic+treatment+of+regular+supraveentricular+tachycardia&aulast=Baker&pid=%3Cauthor%3EBaker+A.%3BWhitbread+M.%3BRichmond+L.%3BKirkby+C.%3BRobinson+G.%3BAntoniou+S.%3BSchilling+R.%3C%2Fauthor%3E%3CAN%3E71283783%3C%2FAN%3E%3CDT%3EConference+Abstract%3C%2FDT%3E This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/openhrt-2015-00028
Planning and implementing community-based drug checking services in Scotland: a qualitative exploration using the consolidated framework for implementation research
No full textInfluence of simulation fidelity on student learning in a prehospital setting
No full textBackground: Simulation creates a low-risk environment for patients and participants and allows experiential learning. Aims: This literature review aims to determine whether the fidelity of simulation (the extent to which it reflects reality) influences learning. Methods: A search of databases for research within the past 10 years was carried out, and 22 articles were reviewed. Findings: Three themes emerged: models of simulation that address fidelity; the role of the facilitator; and need for sound educational theory to underpin simulation. Conclusion: Although evidence is sparse, simulation offers benefits to paramedic students and paramedics. It is particularly useful regarding rarely occurring events, especially those with significant consequences. While a high-fidelity prehospital scenario can be difficult to achieve, simulation can be educationally effective. Effectiveness depends on: the simulation model; whether fidelity is appropriate to the scenario and recognises participants’ sensory capacity; having a dedicated facilitator; and being based on a sound educational strategy. This combination allows learning outcomes to be met and the gap between theory and practice to be bridged. Abstract published with permission
An unusual transmission event of Neisseria meningitidis serogroup W135 type 2a in a healthcare setting, England, 2012
No full textPrehospital serratus anterior plane block for rib fractures
No full textFractured ribs are a leading consequence of blunt chest trauma, afflicting approximately 12% of trauma patients (Kring et al, 2022; Singh et al, 2022). Beyond the physical injury, significant pain is associated with rib fractures, posing challenges in relation to adequate ventilation and carrying a significant risk of secondary morbidity. The resultant shallow tidal breathing due to painful rib fractures and the absence of deep inspiration contribute to hypoxemia, atelectasis, and V/Q mismatching, heightening the susceptibility to pneumonia and respiratory failure. When clinicians strive to provide effective pain control for these injuries, they must navigate the delicate balance of minimising pharmacological complications (especially respiratory depression and hypotension from opioids), while optimising respiratory function and pain relief. Abstract published with permission
Prepping for practice
No full textIn her second column, Alice Cochrane is preparing to put on her paramedic epaulettes. Abstract published with permission
Ambulance service recognition of health inequalities and activities for reduction: an evidence and gap map of the published literature
No full textBackground: Emergency medical services (EMS) are often patients’ first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed. Objectives: This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care. Methods: The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework. Results: The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols. Conclusions: Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery. Abstract published with permission
