bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP23 Improving CPR quality by the innovative use of a CPR quality officer: a simulation randomised control trial
Authors: Sumera Kacper , Ilczak Tomasz , Lane Jon Dearnley , Bakkerud Morten , Pallas Jeremy , Martorell Sandra Ortega , Quinn Tom , Sandars John , Siriwardena Aloysius Niroshan 
Published: August 2022

BackgroundAmbulance services around the world play a pivotal role in the delivery of advanced life support (ALS) in an out of hospital setting. The European Resuscitation Council guidelines highlight the importance of high-quality cardiopulmonary resuscitation (CPR) and early defibrillation for out-of-hospital advanced life support, with the quality of CPR associated with patient outcomes. Despite this importance, research suggests that there is variable quality of ALS in out of hospital settings.MethodsA multicentre simulation randomised controlled trial was conducted to measure the effectiveness of introducing a CPR quality officer role in supervising and maintaining the quality of CPR in ALS. The data was collected by a research team that undertook training from the principal researcher.The participants were ALS trained paramedic students who had experience responding to out of hospital cardiac arrests. The participants were randomised into an intervention and control group and asked to undertake two simulated scenarios, one employing the CPR quality officer, the other without.The primary outcome measure was the compression score calculated by Laerdal QCPR® software. The score was represented as an overall percentage, illustrating the quality of performed chest compressions, interruptions, and chest recoil.ResultsThis is a work in progress, with full data collection now completed. The trial pilot results produced reported an increased overall QCPR score, reduced interruptions, improved chest recoil and an improved chest compression fraction.Qualitative data from focus groups identified that participants were supportive of the inclusion of the CPR quality officer and did not feel the role interfered with their ALS efforts.ConclusionsThe addition of a designated CPR quality officer addresses a fundamental component within the chain of survival. High-quality sustained CPR positively correlates with patient outcomes. Furthermore, assigning a designated CPR officer affords other team members to focus on their tasks. This inclusion is simple, cost-effective and can be utilised in an array of healthcare settings.
PP26 Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and emergency department staff: protocol for a mixed methods study
Authors: Sampson Fiona C , Bell Fiona , Webster Peter , Coster Joanne , O’Hara Rachael , Goodacre Steve , Foster Alexis , Miles Jamie , Millins Mark , Pountney Andrew , Rosser Andy , Spaight Robert , Turner Janette , Boyd Aimee , Pilbery Richard , Long Jaqui 
Published: August 2022

BackgroundAmbulance clinicians use pre-alert calls to inform receiving emergency departments (EDs) of the arrival of a critically unwell patient that will require a specialised response. Little is known about how a decision to pre-alert is made and how this is communicated and acted upon in the receiving ED. Whilst appropriate use of pre-alerts benefits patient care, their overuse carries a risk of harm or opportunity costs. The impact of pre-alerts on ambulance clinicians, ED staff and patients is not currently well understood.MethodsWe are conducting a mixed methods study with five inter-related work packages. We will analyse 12 months of routine data from ambulance pre-alerts in three regions to identify factors in the variation of pre-alert use, including pre-hospital decision-making. We will undertake a national online Qualtrics survey of ambulance clinician perspectives and experience of pre-alerts. We will explore the impacts of a pre-alert on staff, ED facilities and the patient using semi-structured interviews with ambulance clinicians, ED staff, patients and carers and undertake non-participant observation of ED pre-alert response.Expected ResultsWe will describe current pre-alert practice using 12 months’ data for 3 Ambulance Services, including volume and types of pre-alerts. We will identify specific conditions or patient groups for whom pre-alerts are most likely to lead to change in clinical practice, or for whom action is unlikely to provide benefit. We will hold a feedback workshop in which we will share and discuss our findings with key stakeholders.ConclusionsCurrent variation in pre-alert processes, both pre-hospital and in-hospital and the impact on patient care is not understood. The outputs of this study will establish an evidence base to update national guidance for pre-alert practice and identify areas of good pre-alert practice for both ambulance service and Emergency Department staff.
PP27 NHS 111 staff and user views of online NHS 111: a useful adjunct to the NHS 111 telephone service
Authors: Sampson Fiona C , Turner Janette , Knowles Emma , Long Jaqui , Coster Joanne 
Published: August 2022

IntroductionIn 2018 the online NHS111 service was introduced in response to increasing and unsustainable demand for NHS111 telephone service. We explored user and staff perspectives of the online service to understand awareness and acceptability of the online service, how the online service is used and how it may affect demand for the NHS111 telephone service.MethodsWe used data from the national online NHS111 user survey and telephone user survey for two NHS111 areas. We also undertook semi-structured interviews with 32 recent users of online NHS111 and 16 staff and stakeholders from NHS111 sites. We analysed data for 3728 online users and 795 telephone users in SPSS. Qualitative data was analysed using thematic analysis.ResultsOnline NHS111 was perceived as a useful low-risk, low-cost anonymous alternative to the telephone service that could be used instead of, or prior to calling NHS111, particularly for lower-acuity conditions. Staff and stakeholders characterised online and telephone 111 as separate services, with different audiences and purposes. User satisfaction and compliance with advice was lower for online than telephone NHS111 for all measures. Participants appeared to value advice from telephone NHS111 more highly, due to health adviser skills in probing and obtaining ‘soft information’. This was perceived to lead to more appropriate and trusted advice than online interactions, whose questions were considered over-simplified or inappropriate. However, the anonymity, lower pressure and low resource implications of the online service appeared to increase access to NHS111 services for a subset of users who would not otherwise access the telephone service.ConclusionsOnline NHS111 has a useful role in the emergency and urgent care system, but as an adjunct to, rather than replacement of, telephone NHS111. Human interactions associated with the telephone service were seen as key to users obtaining appropriate and trusted advice in many instances.
PP28 Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow test and direct admissions pathway: exploring why well received ideas have low uptake
Authors: Sampson Fiona C , Coster Joanne , Bell Fiona , Miller Elisha , Easom Nicholas 
Published: August 2022

BackgroundIn 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 amongst paramedics, we undertook a service evaluation to assess reasons for low uptake and perceived potential benefits and risks associated with the pilot.MethodsWe 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 according to the principles of Braun & Clarke (Ref).ResultsParticipants 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. 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.ConclusionsAmbulance 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.
PP29 Aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major in Pakistan: a qualitative study
Authors: Hammad Muhammad 
Published: August 2022

BackgroundChronic patients with thalassemia major were mainly recognized as more prone to bad mental health during COVID-19 pandemic. However, why this populace has confronted these detrimental effects, how they have skilled them and the way they have coped, stays under-explored.AimThe aim was to evaluate the aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major and to identify the coping strategies to overcome the effects.MethodsThe present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 21 patients with thalassemia major selected through probability consecutive sampling. All interviews were recorded, transcribed, and analysed with reflexive thematic analysis.ResultsThe most commonly described mental health condition was depression and concern of overall health status.Seven associated pandemic elements contributed in deterioration of mental health: i) Isolation at home, ii) Disrupt transfusion services, iii) Change in appetite and interests, iv) Uncertainty and lack of control, v) Intensive media coverage, vi) Worsening of chronic health problems, vii) Difficulty in sleeping.Four coping strategies were identified for maintaining mental health: i) Practicing gratitude ii) Engaging in hobbies and activities, iii) Stay connected with others, iv) Discern social support.ConclusionsThalassemia major patients had been negatively affected during the pandemic. However, it seems a temporary respite for few, drew upon reserves of resilience and tailored their coping techniques to hold high quality wellbeing.
03 Home truths and long lies? Ambulance calls to fallen patients in residential care facilities within an English clinical commissioning group
Authors: Miller Josh , Barlow Andrew , Khashu Vivek 
Published: August 2022

BackgroundFallen patients who remain immobile for prolonged periods are at risk of rhabdomyolysis and pressure ulcers. Local factors such as training, equipment, and policies may impact whether residential care staff call emergency services for the fallen patient, rather than residential staff managing their care.MethodsWe used routine computer-aided dispatch data within one urban Clinical Commissioning Group (CCG), during the period 1st April 2021 to 31st October 2021, identifying all falls attended by ambulance at nursing, care or residential facilities. We used the percentage of fallen patients not conveyed to hospital as a proxy measure suggesting that homes were calling ambulance services for patients who may only have needed assistance from the floor, while recognising that there are other reasons why patients may have ambulance attendance and not be transported.ResultsWithin the CCG, there were 763 ambulance attendances for falls in nursing, care or residential facilities within the seven-month period, with a median response time of 87 minutes (IQR 28-207). 315 (41%) of these calls were non-conveyances. The calls came from 126 homes across the CCG, which demonstrated marked variation from 35 (28%) having no non-conveyed falls, through to 11 (9%) having only non-conveyed falls – no patients taken to hospital. We identified 17 homes who had both high rates of non-conveyed falls and high overall rates of fallers (top quintile for each), and shared this with the relevant CCG, who found that local factors such as ‘no-lift’ policies and lack of equipment do exist at some of these sites.ConclusionsFallen patients in residential homes experience long waits for ambulance care, but two-fifths of these patients receive no onward hospital transport. A low-burden query of routine data identified a group of care homes where initiatives around training, equipment and policies might improve the care of these patients.
PP30 Comparing on-scene times and conveyance rates in medical, traumatic and psychiatric presentations to the ambulance service
Authors: Corrall Richard , Marks Dougie 
Published: August 2022

BackgroundWhilst psychiatric presentations represent 10-12% of ambulance service demand, research into such presentations is disproportionately sparce. This study builds on literature which explores psychiatric dispositions by comparing conveyance rate and on-scene times with other common ambulance service presentations.MethodsThis study was a single centre retrospective observational study investigating on scene time and conveyance rate variances between medical, traumatic and psychiatric presentations to the ambulance service. Call timings and disposition were recorded from computer aided dispatch data and clinical impressions from associated electronic patient records were used to categorise cases. 720 records were sampled between January and December 2019, consisting of 20 randomised cases per month per case type.ResultsAnalysis of variance identified a statistically significant effect of case type on on-scene time (F(2,717) = 7.14), p = 0.001, η2= 0.02) and conveyance rate (F(2,717) = 8.59, p < 0.001, η2= 0.02). Across all dispositions patients medical cases required 8.18 fewer minutes (p < 0.001, 95% CI[3.65,12.7]) on-scene than psychiatric cases and 6.67 fewer minutes (p = 0.004, 95% CI[2.14,11.19]) than trauma cases. Psychiatric on-scene times were 9.9 (p = <0.001, 95% CI [3.53, 16.29]) and 10 (p = 0.001, 95% CI [4.37, 15.70]) minutes longer than medical and trauma cases where patients were not conveyed to hospital. Conveyance rates were 15% (p = 0.001, 95% CI[-0.23, -0.06]) lower and 17% (p < 0.001, 95% CI[-0.26, -0.08]) lower in psychiatric and trauma cases respectively than medical cases.ConclusionPsychiatric on-scene times were longer than medical presentations irrespective of conveyance and longer than both medical and traumatic presentations where patients were not conveyed. Conveyance rates in psychiatric presentations were lower than medical cases. Further research is required to understand factors which may contribute to this variation and how this may impact on service and care delivery.
PP32 Airway management of cardiac and respiratory arrest patients in the pre-hospital environment
Authors: Clarke Liam , Shaw Joanna , Fothergill Rachael 
Published: August 2022

BackgroundSuccessful airway management is a fundamental part of cardiac and respiratory arrest care. Since our last airway management record review in 2010, the supraglottic airway (SGA) has replaced endotracheal intubation (ETI) as the primary advanced airway intervention, and the i-Gel has become the SGA device of choice. This re-audit aimed to assess for improvements since 2010 and ensure all aspects of essential and advanced airway management are being carried out effectively.MethodsA retrospective review of 384 cardiac and respiratory arrest clinical records were assessed against standards of care derived from national and local ambulance service guidance.ResultsImprovement was evidenced in the following areas: clearance of the patient’s airway (+14%; 100%, n=237/237); use of simple manoeuvres (+11%; 99%, n=377/382), and documentation of high flow oxygen (+12%; 88%, n=336/381). There was a reduction in the documented use of simple adjuncts (-2%; 86%, n=320/373). An advanced airway was attempted for 100% (n=325/325) of patients clinically indicated to receive one and was successful for 98% (n=317/325). An SGA was attempted for 100% (n=290/290) of clinically indicated patients, and an ETI for 98% (n=116/118). EtCO2 values were recorded for 98% (n=309/317) of patients, and 79% (n=249/317) had a capnograph printout submitted showing a box wave-form.ConclusionsFindings indicate improvements since 2010 in many areas of essential airway management, and that advanced airways were frequently successfully placed, with the SGA the most commonly used method. However, further improvement is required in the documentation of the administration of high flow oxygen, the use of simple adjuncts, and the submission of capnography printouts. To ensure a focus on these areas, amendments have been proposed to the Trust’s continual audit process which allows for individualised feedback tailored to each clinician.
PP33 Use of point of care ultrasound in prehospital care: an interview study
Authors: Akanuwe Joseph , Niroshan Siriwardena Aloysius , Bidaut Luc , Mitchell Pauline , Bird Paul , Lasserson Dan , Lilford Richard 
Published: August 2022

BackgroundPoint of Care Ultrasound (PoCUS) is a currently available and rapidly developing technology but still not widely used in the UK. Prehospital PoCUS could help to prioritise initial treatment, procedures and appropriate patient conveyance.A recent literature review suggests that the image quality, portability and cost of ultrasound devices are improving with widening indications for prehospital PoCUS but evidence of prehospital use and impact is needed in the UK. We aimed to explore the views of practitioners (who use ultrasound in practice) on the potential role of PoCUS and the facilitators associated with its use in prehospital care.MethodsWe conducted a qualitative interview study using purposive sampling through social media and a snowballing technique to recruit eligible participants. Individual interviews were conducted online via Microsoft Teams. The interviews were recorded, transcribed and analysed using a Thematic Framework approach assisted by NVivo 12 software until data saturation.ResultsIn total, 16 practitioners aged between 36 and 62 years, with a range of professional backgrounds including paramedics and prehospital emergency physicians, participated in interviews. Participants identified several facilitators to support a widespread implementation of PoCUS in prehospital care: resource requirements for purchase and deployment of devices, sufficient time and a skilled workforce; paying special attention to training, education and support needs; ensuring there is proper organisational governance, guidelines and quality assurance; and including supportive staff, champions and leadership in workforce considerations. Enabling ease of use in aiding decision making and taking unintended consequences or incidental findings into consideration; and more robust evidence to support perceptions of improved patient outcomes and experience, were also identified as facilitators.ConclusionsPrehospital PoCUS could be a useful intervention for improving care processes and patient health outcomes. However, the facilitators identified should be considered for a widespread implementation of prehospital PoCUS.
PP35 Predictors and effects of prehospital feedback: protocol for a mixed-methods diary study
Authors: Wilson Caitlin , Budworth Luke , Janes Gillian , Lawton Rebecca , Benn Jonathan 
Published: August 2022

BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback.MethodsThis will be an observational mixed-methods study involving a baseline survey, diary entries and a follow-up survey. The emphasis of data collection is quantitative survey data, which is supported by qualitative open-ended survey items that will be integrated using triangulation. Data analysis will involve logistic regression (baseline survey), multilevel modelling (diary entries) and content analysis (qualitative data). The baseline survey includes questions on demographics, feedback frequency and the Feedback Environment Scale (Steelman et al., 2004). Participants will be asked to complete 10 diary entries for an event where feedback is received and 5 diary entries where feedback is desired but not received. Eligible participants will be NHS ambulance staff delivering face-to-face patient care. Power calculations suggest a sample size of n=325 participants.Results and ConclusionThe findings from this study will demonstrate how feedback characteristics, person and environment variables influence reported feedback effects in the prehospital setting and highlight missed opportunities for feedback.