bluuebunny/crossref_metadata_2025_split huggingface dataset:
PARAMEDIC SUPPLIED “TAKE HOME” NALOXONE: A RANDOMISED FEASIBILITY STUDY
Authors: Moore Chris , Lloyd Gregory , Oretti Rossana , Russell Ian , Snooks Helen 
Published: April 2015

Background“Take Home” Naloxone (THN) kits for use by peers in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for patients who have suffered an overdose presents an opportunity to distribute THN kits. In this feasibility study we will assess the acceptability of this intervention, and gather data to inform definitive trial planning.Design and methodsCluster randomised trial with staggered allocation of paramedics (clusters) to groups. We will invite paramedics in an urban area of south Wales, UK to participate. Paramedics will be randomly allocated to training sessions during the first four-months of the trial. Patients attended by paramedics who have been trained and issued THN kits will fall into the intervention group. Patients attended by paramedics following usual practice (until they receive their training and THN kits) will fall into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended Emergency Department, suffered further overdose, died during study period and about follow up rates: numbers of patients consented, completed (postal or telephone) questionnaire. We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups.DiscussionNaloxone is considered a very safe drug with few known side effects. However, drug taking or help seeking behaviours may be altered by the provision of the kits and evidence is required to underpin widespread implementation of this new route for THN. This feasibility study will determine the acceptability of the intervention to patients and practitioners, casemix, volume and demographics; recruitment and follow up rates; and preliminary outcome data to inform definitive trial planning.
IMPLEMENTATION OF A NOVEL INTERVENTION TO CARE FOR ELDERLY PATIENTS WHO FALL: PARAMEDICS' VIEWS
Authors: Chatters Robin , Porter Alison 
Published: April 2015

BackgroundThe SAFER 2 study, in three UK ambulance services, evaluated a complex intervention to support paramedics safely to leave older patients at home with referral to a falls service, following a call to 999 for a fall. The intervention comprised a training programme, referral pathway, clinical support, clinical decision flowchart and referral feedback. Normalisation Process Theory (NPT) examines the factors required for successful implementation of an intervention such as SAFER 2 into routine practice, through four components: coherence, cognitive participation, collective action and reflexive monitoring. We used NPT to frame an analysis of paramedics' views of implementation of SAFER 2.MethodsFocus groups and individual interviews were carried out with paramedics before and after the trial, and were recorded and transcribed in full. Transcripts were analysed using the framework approach, informed by NPT, by a team of four researchers.ResultsPre-trial, there were was not a clear or consistent understanding across sites of what the intervention was, and how it was distinct from similar interventions (coherence). Paramedics anticipated benefits of the new intervention, including improved patient care and job satisfaction, and thought that the referral pathway would be used widely (cognitive participation). During the trial, paramedics found that implementing the intervention led to increases of time on scene (Collective action). The intervention was perceived as advantageous to the ambulance service and patients in post-trial focus groups; paramedics from all three sites suggested improvements to the process which included simplification of the intervention (reflexive monitoring).ConclusionUsage of NPT to support analysis of paramedic views on implementation of the SAFER 2 intervention highlighted issues with coherence and collective action that may have affected the trial. The novel intervention was seen as beneficial by paramedics during both pre- and post-trial interviews, although barriers to utilisation were identified.
UNPLANNED, URGENT AND EMERGENCY CARE: WHAT ARE THE ROLES EMS PROVIDE FOR OLDER PEOPLE WITH DEMENTIA? A LITERATURE REVIEW AND NARRATIVE SYNTHESIS
Authors: Buswell Marina , Martin Steven , Lee Caroline , Lumbard Phillip , Prothero Larissa 
Published: April 2015

BackgroundAnecdotally emergency ambulance crews say they frequently encounter older people with dementia (OPWD) and it can be difficult to take history, assess pain and access suitable alternatives to the emergency department especially out of hours. With the current policy landscape of the NHS England Emergency & Urgent Care Review and the high profile of dementia care it is pertinent to ask what role emergency medical services (EMS) have in the urgent and emergency care of OPWD.MethodsAware that the research literature in this area was likely to be sparse we used systematic and iterative search techniques to identify relevant studies and documents. All databases available via NHS Evidence were searched and grey literature was included. Articles which made any reference to the pre-hospital role of EMS ambulance services/personnel in the urgent or emergency care of OPWD were included. Discharge roles were excluded.ResultsNineteen relevant documents were included for review and synthesis, over half from the grey literature. Eight were specifically about EMS treating OPWD, six of those from the grey literature. The other documents, though mentioning the role, were not researching or evaluating that role.We identified three roles described in the literature; emergency transport, assess and manage, and a last resort/safety net role. This final role is alluded to in over one third of the documents but is not investigated.Conclusions and recommendationsThis review highlights a gap in our understanding and in the research literature about the role EMS play in the care of OPWD, particularly around the last resort/safety net role. We hope it will encourage researchers from EMS and dementia care disciplines to come together, particularly to look at:▸ Better understanding the last resort/safety net role.▸ Evaluating AND reporting in the research literature initiatives that are happening in EMS around caring for OPWD.
TRIALS AND TRIBULATIONS: THE STORY OF THE SAFER 2 STUDY
Authors: Chatters Robin , Snooks Helen , Gaze Sarah , Koniotou Marina 
Published: April 2015

BackgroundThe 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.MethodsInformation regarding the progress of the study was sought from study staff, study timelines and quarterly reports sent to the study funders (HTA). General information regarding study progress, as well as events that caused unforeseen set-backs to the study timetable were extracted from these sources and the “story” of the study written in chronological order.ResultsProgress was delayed by a decision by the NIGB to reject an application to access patient's records without consent; we therefore required written consent from patients that would be particularly difficult to obtain. Following ethical approval in February 2010 (11 months behind schedule), the study team worked to confirm participating sites—two falls services within Nottingham had to decline participation, as well as a Health Board within Wales. In early 2010 participating services were confirmed, allowing R&D approvals to be gained for 26 participating trusts. Patient recruitment started in early 2011. Due to issues with patient throughput and retrieval of patient demographics to assess eligibility, a funded extension was granted by the HTA in order to extend recruitment until June 2012.DiscussionEvaluation of the study was delayed due to issues with ethical approval, site participation and patient eligibility screening and recruitment. Other studies, in other areas of research, have had similar issues, including the COnStRUCT and Family Links studies, which were set-back due to issues with NHS R&D approvals and attribution of costs.
STOCKLIST—A STUDY OF CLINICAL SKILLS OF CRITICAL CARE PARAMEDICS IN THE UK
Authors: Walmsley Jim , Turner Janette 
Published: April 2015

IntroductionThe Critical Care Paramedic (CCP) is a relatively new advanced practitioner. CCPs provide advanced clinical skills, knowledge and expertise for primary response and critical care retrieval and transfer. In the UK it is currently an undefined role with no common code of practice, clinical governance or national guidance. The aim of this study was to explore the current use of CCPs and assess the views of a range of stakeholders on the required skills and role development within a British context.How important are the following generic standards?Yes n (%)No n (%)Don't Know n (%)Non Response n (%)Core Competencies95 (68.3)1 (0.7)2 (1.4)41 (29.5)Clinical Governance95 (68.3)1 (0.7)2 (1.4)41 (29.5)Minimum educational standards90 (64.7)4 (2.9)4 (2.9)41 (29.5)National CCP Qualification91 (65.5)1 (0.7)6 (4.3)41 (29.5)Continuous Professional Development93 (66.9)1 (0.7)2 (1.4)43 (30.9)Views about the CCP roleAgree n (%)Disagree n (%)Unsure n (%)Non Response n (%)Can learn from other ‘practitioner’ roles88 (63.3)0 (0)3 (2.2)48 (34.5)Is of limited benefit16 (11.5)69 (49.7)6 (4.3)48 (34.5)Provides an economic advantage55 (39.5)12 (8.7)24 (17.3)48 (34.5)Can't be cost effective.64 (46.1)5 (3.6)22 (15.8)48 (34.5)Fulfills a clinical need82 (59)5 (3.6)4 (2.9)48 (34.5)Should deliver pre-hospital critical care80 (57.6)6 (4.3)5 (3.6)48 (34.5)Should lead pre-hospital critical care51 (36.7)18 (12.9)22 (15.8)48 (34.5)Has the potential to have an impact81 (58.2)1 (0.7)9 (6.5)48 (34.5)Can keep up with rising demand62 (44.6)5 (3.6)24 (17.3)48 (34.5)Is an expensive luxury6 (4.3)66 (47.4)19 (13.7)48 (34.5)Needs opportunities to be effective87 (62.5)0 (0)4 (2.9)48 (34.5)Is not relevant to the provision of care3 (2.1)78 (56.1)10 (7.2)48 (34.5)MethodsA web based survey design was used to collect information on CCP use and views on skills, role and scope of practice. The survey asked questions on current or intended use of CCPs and skills used. Respondents were asked to rate a list of 23 clinical skills on whether they were essential, desirable or irrelevant; importance of a set of standards and statements about the role of CCPs in the ambulance service. Stakeholders approached included ambulance services, professional bodies, charitable organisations and academic departments.ResultsFrom 198 invitations there were 141 responses (70%) and 70% were from ambulance trusts. Half of responders said they currently used CCPs. The top 5 essential skills were concerned with airway management. Views on core standards and the CCP role are summarised in the table.ConclusionsThe survey confirmed the CCP role is currently undefined and used variably in practice. There was agreement on the need for core skills and standards but the nature of these is still a matter for debate.
PELVIC FRACTURES IN MOUNTAIN CASUALTIES IN SNOWDONIA: TO STRAP OR NOT TO STRAP?
Authors: Browne Hannah , Dykes Linda 
Published: April 2015

BackgroundMountain Rescue Teams in Snowdonia endeavour to use pelvic splints as per JRCALC guidelines. However, mountain casualties with major mechanisms of injury are often found in precarious locations where application of splints is challenging. We wondered whether the pelvic fractures seen in mountain casualties are of the type likely to benefit from splintage.MethodThe Bangor Mountain Medicine database (all casualties brought to Ysbyty Gwynedd following contact with MRT and/or RAF SAR helicopter) Jan 2004–October 2012 was interrogated and pelvic fracture cases identified.Fracture type was analysed from all available imaging using the Tile classification by a Consultant musculoskeletal radiologist. For fatalities, post-mortem reports were examined.ResultsOf 913 casualties in the study period, 730 (80%) were injured rather than ill.18/730 (2.5%) of trauma casualties had a confirmed pelvic fracture.14/18 (78%) had fallen from height; 2 were mountain-biking; one crashed his paraglider and one sustained an acetabular fracture in a simple fall.4.3% of casualties who had fallen from a height greater than standing sustained a pelvic fracture.2/18 died at scene: post-mortem reports implied severe pelvic disruption but could not be classified further.In a further 3 cases, imaging was not available, leaving 13 cases for radiological analysis.13/13 (100%) of fractures could be classified using the Tile system: 61% A1, 31% A2 and 8% C2.ConclusionPelvic fractures are uncommon in Snowdonia mountain casualties, and, in survivors, the vast majority are stable (92%, cf. 55% in urban casualties). Severe pelvic disruption was seen only in casualties declared dead at scene.Only one casualty in a nine-year period had a pelvic fracture that might benefit from a pelvic splint. Our data suggests that application of pelvic splints need not be considered a high priority in mountain casualties, especially in precarious locations.
PROFESSIONALISM AND CARE: THE DAILY BREAD AND BUTTER OF A PARAMEDIC ATTENDING PATIENTS WHO FALL
Authors: Simmonds Bethany , Clarke Shane , Bradley Rachel , Benger Jonathan , Gooberman-Hill Rachael 
Published: April 2015

Falls occur increasingly frequently with age. 35% of people aged over 65 fall each year rising to 50% at age 85. Many patients fall repeatedly. 56% of patients attending an emergency department were recurrent fallers, and 55% of patients presenting with an acute fracture had previously fallen.Fracturing bones is closely linked to falling and carries great costs both for the NHS and the individual. Paramedics do not routinely assess bone health (fracture risk) in people who fall. This is why a study called ‘The OAK Project’ is being carried out the South West of England to see if it is feasible for paramedics to collect FRAX (The Fracture Risk Assessment Tool) data and whether GPs will put patients with a high risk of fracture on osteoporosis treatment.A significant element of this feasibility study is a qualitative nested study exploring the acceptability of using FRAX amongst patients and paramedics. When shadowing paramedics (n=6), the level of professionalism and care paramedics gave to patients who fell was striking. Paramedics made clinical assessments, gave personal care, emotional support and provided patients with a high level of dignity.When questioned about frequent fallers in interviews (n=12), paramedics felt that in many cases everything possible was being done. GPs are quite often aware of their frequent falling patients, home adaptations had been made, often are already taking medications for osteoporosis, they have personal alarms, home carers who visited frequently and fall assessments had been carried out. Additionally, paramedics felt that some patients do not want to be helped and felt there is a limit to what can be done to prevent people from falling in their own homes.This presentation will provide an insight into the levels of care and professionalism that paramedics demonstrate when attending people who fall in everyday practice.
SICKER FROM THE START: COPD EXACERBATION AND DISTANCE TO HOSPITAL
Authors: Bassir Leila , Dykes Linda , Perry Rob 
Published: April 2015

IntroductionWe 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.MethodsWe 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.▸ We calculated the NHS Early Warning Score (NEWS) on ambulance arrival at scene (“pickup”), and on arrival in ED (“arrival”), and plotted this against distance to hospital.ResultsMean NEWS score on pickup and arrival showed a gradual linear increase (6/7 to 8/9) with increasing distance from hospital.▸ Pickup and arrival scores were similar except for patients travelling >35 miles (n=4) whose NEWS rose from 6–8 to 12.DiscussionThese results support our observation that COPD patients living a long way from hospital are sicker on arrival in ED: but they are sicker to start with. Almost everyone arrives at hospital approximately as sick as they were on ambulance arrival, the exception being a small subgroup living furthest from the hospital (35–40 miles).Our data are retrospective and preliminary: numbers are too small for statistical analysis. However, they suggest that COPD patients in rural areas are already sicker—possibly seeking help later—than those living nearby. A larger study is needed to confirm these results and investigate why: is it rural GPs, their patients, or both, who have a higher threshold for hospital admission than those living closer?Rural PHEM service planners should consider that paramedics in rural areas not only have longer transport times to hospital, but may also be caring for sicker patients than their urban counterparts.
INVESTIGATING PATIENTS EXPERIENCES OF HYPOGLYCAEMIC EMERGENCIES
Authors: Fitzpatrick D , Duncan E 
Published: April 2015

BackgroundIn Scotland approximately 70% of patients with diabetes treated for a hypoglycaemic event by ambulance clinicians remain at home after treatment. However, many of these individuals experience repeat or subsequent hypoglycaemic events. Current clinical guidance recommends that individuals are advised to follow-up care with their GP, however evidence suggests only a minority make these appointments. The reasons for this are unknown.AimTo investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency.MethodsIn depth interviews undertaken with adults with diabetes who have experienced a hypoglycaemic emergency treated by Scottish Ambulance Service ambulance clinicians. Data was analysed thematically.FindingsTwenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; demonstrating that the patient's misinterpretation or lack of symptoms as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; finding that patients felt care provided was good and dependable and that recovery was predictable. Advice given by ambulance clinicians was found to be inconsistent. Thirdly, the influences on uptake of follow-up care; preferences for follow-up care were influenced by previous experiences of home, hospital and primary care.LimitationsThe study found it hard to recruit younger participants (i.e. 16–25 years). Participants' recollection of events on recovery may have been confused due to problems associated with post hypoglycaemic cognitive impairment.ConclusionMany patients do not perceive immediate hospital care or follow-up care with their diabetes care provider post hypoglycaemic event to be beneficial.RecommendationInterventions aimed at improving self-referral for follow-up care are required to address these perceptions.
MODIFIED EARLY WARNING SCORES (MEWS) TO SUPPORT AMBULANCE CLINICIANS' DECISIONS TO TRANSPORT OR TREAT AT HOME
Authors: Essam Nadya , Windle Karen , Mullineaux David , Knowles Stacey , Gray James , Siriwardena Niroshan 
Published: April 2015

IntroductionModified Early Warning Scores (MEWS), calculated from patients' vital signs, are used in hospital to identify patients who may benefit from admission or intensive care: higher MEWS indicates greater clinical risk. We aimed to evaluate MEWS to support paramedics' decisions to transport patients to hospital or treat and leave them at home.MethodsWe used an interrupted time series design. We trained 19 volunteer paramedics to use MEWS to support decisions to transport or treat and leave at home. We used linear regression to evaluate differences in weekly transportation rates (percentage of patients attended and transported to hospital) and revisit rates (percentage of patients attended, treated at home and subsequently revisited within 7 days), comparing trends in rates 17 weeks prior (pre-MEWS) and 17 weeks post implementation of MEWS. Auto-calculated scores retrospectively applied to all data provided pre-MEWS and were compared with paramedic calculated scores post-MEWS.ResultsOf the 4140 patients attended, 2208 were excluded owing to missing values (n=1897), recording errors (n=21) or excluded clinical complaints (n=290). From the remaining data (n=1932) there were no significant differences in transportation rates (pre=55±6%; post=63±11%) by catering for the existing increasing trends where the confidence intervals of the regression slopes overlap (pre=0.15; 95%CI −0.51 to 0.80 vs. post=0.54; −0.58 to 1.65). Similarly, there were no significant difference in revisit rates (pre=4±4%; post=2±4%) catering for the similar trends (pre=−0.13; −0.53 to 0.27 vs. post=0.08; −0.33 to 0.49). Paramedic scores were incorrect 39% of the time (n=622).ConclusionMEWS had a minimal effect on transportation or revisit rates. Scores were frequently not calculated or recorded, or incorrectly calculated. Opportunities for ongoing training, clinical support and feedback were limited. A larger study, ensuring adequate ongoing support, is recommended before implementing MEWS on a wider scale.