bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP21  Perceptions and experiences of employee mental health support: a cross-sectional survey of UK ambulance service staff
Authors: Johnston Sasha , Wild Jennifer , Sanderson Kristy , Kent Bridie 
Published: September 2020

BackgroundMental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, staff experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. To identify whether organisational support meets staff needs, this research explored the perceptions and experiences of staff working in a large ambulance trust covering the south west of England.MethodsBetween September and October 2018, ambulance staff were invited to complete an online questionnaire, which assessed demographics, work-related stressful life events, related psychological impact assessed by the avoidant subscale of Weiss and Marmar’s Impact of Event Scale-Revised, mental ill health sickness absence during the previous 12 months, perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time-to-talk at work.ResultsOver 11% (N=540) of the workforce responded. The majority reported experiencing work-related stressful life events (n=444; 82%), that were associated with subsequent avoidant symptoms. Avoidant symptom severity peaked between six-months to five-years after an event (F(5,438) = 2.4,p=0.03), was associated with repeated exposure (F(4,439) = 2.9,p=0.01) and to sickness absence. A fifth of participants reported mental ill health sickness absence (21.6%), a third of which was not disclosed as related to mental health. Content analysis identified stigma, fear, as well as embarrassment, as barriers to disclosure and help-seeking. Perceptions and experiences of organisational support were significantly correlated (r(195) =0.46,p<0.001) and positive.ConclusionsSymptoms associated with work-related stressful life events can persist for years among ambulance staff. Given the association between organisational support and mental wellbeing, it is possible that an intervention, such as mandatory time-to-talk, supported at an organisation level could improve wellbeing among ambulance staff. Such an intervention needs to be evaluated in future research.
PP24  Does a paramedic practitioner self-tasking dispatch model benefit their self-sufficiency in patient management? A cross sectional study
Authors: Cotterill Liam , Halter Mary 
Published: September 2020

BackgroundParamedic Practitioner (PP) scope of practice is not comprehensively understood by Emergency Operations Centre (EOC) staff and tasking may be suboptimal. In one UK ambulance trust in November 2018, one PP team was enabled to remotely monitor live incidents and, alongside some continued EOC-dispatch, to self-task to incidents they judged would benefit from their additional knowledge and skills. Evidence on self-tasking benefit was found from helicopter emergency services only.MethodsA retrospective cross-sectional study was utilised to evaluate the impact on self-sufficiency - defined as incidents completed by a PP without the need for further ambulance resources - and conveyance rates of PPs utilising a ‘self-tasking’ dispatch model. PP-completed shift reports were collected over a 6-month period from ten PPs working in one trust locality. Excluded cases: Category-1 calls, healthcare professional calls, PP referrals and back-up requests originating from on-scene ambulance clinicians. Descriptive statistics were used to compare rates of self-sufficiency and conveyance between self-tasked and EOC-dispatched incidents.ResultsShift reports detailing 964 incidents were analysed; 705 were self-tasked and 259 were EOC-tasked. PPs showed a statistically significant increase in self-sufficiency when utilising the self-tasking method of dispatch compared to EOC initiated dispatch (88% self-tasked versus 72% EOC-tasked, χ240.4, df 1, p<0.01). There was also an increased non-conveyance rate self-tasking compared to EOC-led tasking (64% versus 56%, χ25.3, df 1, p<0.05).ConclusionsPPs appear to find it easier to identify incidents suited to their scope to be self-sufficient than EOC staff. This study is a small-scale evaluation in one site, does not adjust for confounders, and does not constitute a direct comparison of the two models. There remains a need for more rigorous research on this topic, though this evaluation suggests that there may be benefits to be gained from PPs self-tasking.
PP25  Does unguided cardio-pulmonary-resuscitation in copenhagen achieve high quality recommendations?
Authors: Lyngby Rasmus Meyer , Nikoletou Dimitra , Folke Fredrik , Quinn Tom 
Published: September 2020

BackgroundSurvival from out-of-hospital cardiac arrest (OHCA) is associated with the quality of cardio-pulmonary-resuscitation (CPR). The European Resuscitation Council (ERC) and American Heart Association (AHA) define high quality CPR as compression depth of 5–6 centimeters, compression rate of 100–120 compressions/minute, full recoil (>400 milliseconds) after each compression and a hands-on time (compression fraction) of at least 60% (ERC) or 80% (AHA). The aim of this study was to investigate if unguided CPR performed by Copenhagen Emergency Medical Services (EMS) met these recommendations.MethodFrom October throughout December 2018, OHCA data were collected from ambulances within the Capital Region of Denmark using Zoll X-series defibrillator (without CPR feedback dashboard or metronome). Only cases where EMS performed CPR were included. Data was uploaded to a central database and extracted to EXCEL for descriptive statistics and preliminary results.ResultsEMS CPR was performed in 330 cases of which 252 were available for analysis. Mean (SD)compression depthwas 5.6±1.7 centimeters,compression ratewas 110±9.8 compressions/minute,release velocitywas 410±125.1 milliseconds,compression quality(correct compression depth + correct compression rate) was 13.8% andcompression fractionwas 69.7%.ConclusionThe quality of EMS-delivered CPR, unguided by feedback or metronome, was within recommendations for compression depth, compression rate and release velocity. CPR fraction was between ERC and AHA guidelines. Compression quality, which is not included in ERC/AHA recommendations, did not reach the manufactures recommended >60%. Further work is ongoing to evaluate the effect of adding real-time feedback to guide EMS CPR.
PP26  Knowledge, attitudes and practices of UK paramedics regarding pharmacology and the legal, management and administration aspects of medicines: a cross-sectional online quantitative survey
Authors: Laws Samantha , Halter Mary , Wang Chao 
Published: September 2020

BackgroundChanges in the paramedic profession have seen an increased range of medicines available within UK ambulances services. However, poor practice in medicines management has been identified by the Care Quality Commission. Literature in this area is sparse. This study aimed to determine the perceived knowledge, attitudes and practices of paramedics regarding pharmacology and the legal and regulatory issues of medicines management and administration.MethodsThe study utilised a cross-sectional survey design, administering an anonymous online survey to all (approximately 1000) paramedics within one UK NHS ambulance trust. The survey focused on paramedic knowledge on pharmacology, legal supply and administration; self-assessment of knowledge and confidence related to medicine management and administration; and personal characteristics. The primary outcome was percentage of (pre-determined) correct answers.Results251 responses were received. The mean percentage of correct answers was 79.0% (SD 10.0), with variation by question observed, from 34.7 to 97.2% correct responses. A higher correct knowledge was associated with: higher self-rated confidence, lower self-reported knowledge, being less likely to report errors and higher education-based initial route into the paramedic profession.ConclusionThis single-site UK-based survey highlighted variation in medicines knowledge amongst self-selecting paramedic respondents. The results indicate a need for medicines-specific further education for all paramedics, particularly those who have not experienced longer formal education entry routes, integrating a focus on confidence and self-perceived knowledge, and enhancing and embedding integrated improvement strategies. Further research is required with larger, multi-site samples, and to evaluate the impact of education packages developed.
PP28  Pros and cons of using anonymised linked routine data to improve efficiency of randomised controlled trials in healthcare: experience in primary and emergency care
Authors: Snooks Helen , Jones Matthew , Khanom Ashra , Lyons Ronan , Watkins Alan 
Published: September 2020

BackgroundThe use of anonymised routine linked data in designing and conducting randomised controlled trials (RCTs) has great potential. Sample sizes can be large, inclusion rates high and follow up periods prolonged, while the disruption to participants’ usual routines may be minimised. However, challenges and limitations in using routine linked data in RCTs remain. We sought to describe challenges and opportunities associated with designing and conducting RCTs using anonymised linked routine data in primary and emergency settings.MethodsSynthesis of trial designs used, regulatory processes followed and findings from three trials: PRISMATIC; SAFER 2; TIMEResultsIn each of these trials we have used routine linked data as a key part of the research study design:PRISMATIC (a stepped wedge trial of predictive risk stratification in primary care) utilised linked data outcomes related to emergency admissions to hospital, GP activity and outpatient appointments. Outcomes were included for 230,000 people registered to participating GP practices in the Swansea areaSAFER 2: a cluster randomised trial of referral to falls services by ambulance paramedics included linked data outcomes related to subsequent emergency episodes for 4,655 patients across three UK regionsTIME: feasibility trial of Take Home Naloxone randomised by city; routine linked data used to identify population for inclusion in follow up and outcomesEthics, research and information governance permissions have caused delay in each trial; inclusion rates have been much higher than is usual in RCTs (outcomes for >80% of eligible patients); large trials have been achievable at reasonable cost (each trial <£2,000,000). Questions remain about differences between self-reported and routinely available outcomes; and between routine data outcomes collected prospectively and through the anonymised linked route.ConclusionsThere are clear benefits in using anonymised linked data outcomes in trials but further research is required to understand costs and limitations
PP29  The paramedic will see you now: understanding new roles in primary care
Authors: Porter Alison , Driscoll Timothy , Edwards Adrian , Evans Bridie , Griffiths Lesley , Hussain Ather , James Mari , Jones Jenna , Keen Leigh , Kingston Mark , Phillips Ceri , Snooks Helen , Thomas Rhys , Watkins Alan , Mclean Grayham 
Published: September 2020

BackgroundIn response to rising healthcare demand and shortages of general practitioners (GPs), policy across the UK supports paramedics joining the clinical team in primary care. Numbers of paramedics in primary care (PPC) are increasing in England and Wales through a range of local initiatives. As the first stage in the ARRIVE feasibility study evaluating PPC, we conducted preliminary qualitative research to:Understand the key components of the PPC intervention and its potential impactsIdentify sites with PPC and describe the range of existing interventionsDevelop a logic model to describe PPC.MethodsWe interviewed a total of 19 stakeholders from across Wales, including Health Board managers, GPs, practice managers and paramedics. Interviews were recorded and transcribed in full, then analysed thematically. We held a stakeholder event, bringing together 21 people involved in commissioning, planning and delivering PPC to discuss the key components of a logic model, including outcome measures for evaluation.ResultsWe developed a logic model describing how paramedics provide direct clinical contact with patients in a primary care setting. Potential positive impacts include better patient experience, reductions in emergency admissions through better proactive care, increased sustainability of primary care, and increased levels of clinical skills and satisfaction for paramedics. Components of the intervention which varied across sites included type of patient contact (home visit or surgery); approaches to patient selection and triage; employment model; training and induction; and clinical supervision and support from GPs.ImplicationsPPC is a rapidly developing area of provision in primary care, but there is great variation in the nature of models which have been implemented, and there is still uncertainty about the risks and benefits of PPC, and about how best to deliver it. Our logic model underpins the ARRIVE feasibility study, which will help to build the evidence base urgently needed on the PPC innovation.
PP30  The ambulance service and the child and young person’s advance care plan: listening to families and professionals
Authors: Shaw Karen , Spry Jenna , Cottrell Serena , Cummins Carole , Fitzmaurice Nicki , Greenfield Sheila , Heath Gemma , Miller Joshua , Neilson Sue , Skrybant Magdalena , Thompson Paul , Vyse Janette 
Published: September 2020

BackgroundThe Child and Young Person’s Advance Care Plan (CYPACP) is a set of resources to help families and professionals agree a plan of care to be followed when a child/young person with a life-limiting condition develops potentially (i) reversible intercurrent illnesses or (ii) life-threatening complications of their condition. It covers clinical, psychosocial and spiritual issues, is designed for use in all environments that the child encounters, and can be used as a resuscitation and/or end-of-life plan. Little is known about the experiences of Ambulance Service staff who receive copies of these plans and may be called upon to follow the recommendations for treatment and resuscitation.MethodsAs part of a regional qualitative research study, families who have a CYPACP and members of the ambulance service were invited to share their views and experiences of the CYPACP via an online survey, in focus groups or individual interviews. Underpinned by an interpretative framework, thematic and linguistic analyses are being used to understand the implementation in ‘real-world’ settings, and how the CYPACP shapes the experience, delivery and quality of care.ResultsTo date 20 families with a CYPACP and 25 members of the ambulance service have taken part. Analysis is on-going. Preliminary findings show that despite families with CYPACPs having multiple experiences of interactions with the ambulance service, it is rare for ambulance crews to attend a call where a child has a CYPACP in place. Findings also suggest that there are critical points within the process of conveying the information contained within the CYPACP document that could be improved.ConclusionFollowing full analysis, it is anticipated that the ambulance services involvement with the CYPACP planning process will be better understood and that improvement strategies, including revision to existing documentation and identification of specific support needs can be made.
PP33  A service evaluation of the experiences of specialist paramedics working in rotational environments using a retrospective cohort
Authors: Creton Daniel , Halter Mary , LaTrobe Clayre 
Published: September 2020

BackgroundThe number of ambulance service-employed paramedic practitioners moving to work in primary care is increasing. Several Health Education England-supported pilot rotational programmes are underway. This study aimed to evaluate the experiences of nine paramedic practitioners in one ambulance service their first year of working on a similar local commissioner-led rotational project (segment one GP home visiting [GPHV], segment two ambulance service solo response vehicle [SRV] and emergency operations control room [EOC] whose aim was to mitigate attrition rates for both the ambulance service and primary care.MethodsWe conducted a retrospective cohort study, using electronic anonymous, self-completion, mixed methods questionnaires administered seven times – pre-project, at the end of each rotation, and at the end of the first year of the rotational project. Descriptive statistics of closed questions on challenges, influence over practice, skills used, satisfaction and likelihood of leaving were conducted, and thematic analysis of the open responses conducted.ResultsThe survey response rate was 100% pre-project, 62.2% (n=28/45) over five rotations (n=15 after GPHV and n=13 after SRV/EOC] and 100% at end year one. Reported challenges included inappropriate utilisation of skills (33% GPHV, 55% SRV/EOC) and poor work life balance (27% GPHV), while opportunities were identified as clinical autonomy, collaboration with other healthcare professionals and clinical development (67%, 60%, 33% GPHV; 54%, 69%, 62% SRV/EOC, respectively). Satisfaction was 67% at year one, attributed to support and development from peers, GPs and immediate managers. Likelihood of leaving was reported to be decreased.ConclusionAlthough small in scale, in one locality and only quantitatively descriptive this study has identified that a rotational model contributes to clinically developing and retaining PPs, and offers PPs’ views on why that is. Findings support the rotational model, though further research with a larger sample across regions and/or greater qualitative depth is required.
PP35  Evaluation of a rotational model of advanced paramedic practice in north wales: a logic model approach to demonstrate effectiveness
Authors: Robertson Duncan , Baines Bob , Nosworthy Gemma , Thomas Wyn , Timmins Mark , Watson Robyn , Wright Stella 
Published: September 2020

BackgroundUK Ambulance Services are under pressure to retain paramedics as diverse career options become increasingly available throughout the NHS for this valuable group of staff. Rotational working is one means of providing a varied clinical portfolio with the aim of sustaining an ambulance service based career over a longer work-span. Prior to implementing a test of an Advanced Paramedic Practitioner (APP) focussed three-part model of rotation which included Primary Care, Clinical Contact Centre and Solo Responding, an effective evaluation framework was required.MethodsThe aims of the project were refined during initial team planning and a project workshop which articulated the conditions for success. The theory of change was subsequently developed through a team-based facilitated session culminating in the development of a driver diagram. Due to the predominantly linear nature of the project and design, a Logic Model approach was selected to then map and construct the detailed evaluations required for each of the key areas identified.ResultsSeven individual elements for evaluation were identified through this design process. These comprised of four core areas including the impact of the rotation on Patients, Primary Care, The APPs and Welsh Ambulance Services NHS Trust which would be managed by the project team. In addition, the framework identified elements suitable for external evaluation which consisted of the economic evaluation, a deeper exploration of patient experiences and project effectiveness. External evaluation would test the validity of the overall approach to the project by the internal team and stakeholders. The derived Logic Models were designed to enable formative and summative evaluation throughout the opening phase of the rotation.ConclusionsUsing this approach, the project team have constructed a robust, but testable model of evaluation, with the flexibility to map changes as the evaluation yields specific learning points about the project.
PP36  Using linked health data to explore compliance with and appropriateness of ambulance telephone advice
Authors: Coster Joanne , O’Cathain Alicia , Nicoll Jon 
Published: September 2020

BackgroundIn England, approximately 10% of patients who contact the ambulance service receive clinical telephone advice rather than a face-to-face ambulance response. This analysis identifies whether patients who receive ambulance telephone advice to attend ED comply with this advice and explores the appropriateness of subsequent ED attendances.MethodsAmbulance CAD, HES (A&E/inpatient) was linked for 2521 hear and treat callers as part of the PhOEBE study. For data linking reasons, the sample includes only patients who had other experiences of contacting the ambulance service. Additional information from the ambulance telephone advice call was linked to the PhOEBE data using the CAD ID and date/time of call. Appropriateness of ED attendances was determined using a method that assesses whether patients receive investigations/treatments in the ED and that appropriateness denotes care that is proportionate to need.ResultsThis analysis is based on 1892/2521 (75%) cases which have both ambulance telephone advice and ED attendance data, as some ambulance advice information was unavailable. 522 patients (28%) attended ED within 3 days of the ambulance call. Of these, 235 were advised by the ambulance service to attend ED. The remaining 287 patients were advised to seek other care, with most advised to seek GP care (n=180). 81.6% of ED attendances were assessed as appropriate. 129 patients were advised to attend ED and did not attend within 3 days.ConclusionsAmbulance telephone advice information was successfully linked to other health-service information. Patients included in this analysis are older and more likely to be sicker than the general hear and treat population, as all had other experiences of using the ambulance service. Most ED attendances were appropriate. Some patients did not comply with advice to attend ED. More research is required to investigate the factors around compliance with advice to attend ED and to find out what happens to these patients.
04  ‘What is the rate of general practitioner registration amongst homeless patients who present to an english ambulance service?’
Authors: Miller Joshua , McBride Shaun 
Published: September 2020

BackgroundMarginalised groups such as homeless people and migrants experience barriers to registration with a general practitioner (GP). While various interventions have been trialed to improve registration rates, the potential for opportunistic interventions through the ambulance service has not yet been considered. The aim of this study was to determine the scope for these interventions by researching the prevalence of GP registration amongst the homeless population that present to a regional English ambulance service that covers both rural and urban areas.MethodsA retrospective search of electronic patient records was carried out for cases where a box for the attending clinician to click to indicate homelessness had been ticked between 1st April 2016 and 30th September 2019. A search of these records for GP registration was then performed.ResultsA total of 14 707 ambulance attendances were marked as being for a homeless patient. 10 511 (71.5%) had a GP recorded, while 4 196 (28.5%) did not. On average, the ambulance service had face-to-face contact with 11.5 homeless patients per day, and 3 face-to-face contacts with patients who did not have GP registration per day.ConclusionThis indicates ambulance services could perform opportunistic interventions to improve GP registration rates amongst the homeless population. The data also suggests that the ambulance service is well-placed to perform other opportunistic interventions targeted at the homeless population.