bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP16 A comparison of Australasian jurisdictional ambulance services’ paramedic clinical practice guidelines series: adult anaphylaxis
Authors: Wilkinson-Stokes Matt , Rowland Desiree , Spencer Maddison , Maria Sonja , Colbeck Marc 
Published: August 2022

BackgroundThis article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and, consequently, differences in patient treatment based on which jurisdiction a patient is geographically located within at the time of their complaint.MethodThe current Clinical Practice Guidelines of each Australasian domestic jurisdictional ambulance service (JAS) were accessed during June 2020 and updated in August 2021. Content was extracted and verified by 18 paramedics or managers representing all 10 JASs.ResultsAll JASs use intramuscular adrenaline as a first-line agent for adult anaphylaxis. Beyond this, significant differences exist in all treatments: five services provide nebulised adrenaline; 10 services provide adrenaline infusions (one requires doctor approval; one provides repeat boluses); six services provide nebulised salbutamol; two services provide salbutamol infusions (one requires doctor approval; one provides repeat boluses); five services provide nebulised ipratropium bromide; eight services provide corticosteroids (two restricted to intensive care paramedics (ICPs)); five services provide antihistamines for non-anaphylactic or post-anaphylactic reactions; four services provide glucagon (one requires doctor approval); magnesium is infused by ICPs in two services; 10 services allow unassisted intubation in anaphylactic arrest; one service allows ICPs to provide sedation-facilitated intubation or ketamine-only breathing intubation; eight services allow rapid sequence induction (two restricted to specialist roles).ConclusionThe JASs in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.
PP17 Differential rater function over time (DRIFT) is not appreciated in paramedic raters using the global rating scale (GRS) during paramedic student simulations
Authors: Diebel Sebastian , Boissonneault Eve , Perreault Luc , Lapierre René 
Published: August 2022

BackgroundThe field of paramedicine continues to advance in scope. Simulation training is frequently used to teach and evaluate students. Simulation examinations are often evaluated using a standardized global rating scale (GRS) that is reliable and valid. However, the effects of differential rater function over time (DRIFT) have not been evaluated on the GRS during simulations. This study aimed to assess if DRIFT exists during a GRS.MethodsData was collected at Collège Boréal, Sudbury, Ontario, Canada during the 6 simulation evaluations within the scholastic year. Raters were randomly assigned to evaluate several students at the same station. Each station lasted 12-minutes in length and there was a total of 11-stations. A model to test the scores of DRIFT was created and was tested against both a leniency and perceptual model to explain DRIFT.ResultsAmongst the explored alternatives, a model that included students, the rater, and the dimensions had the greatest evidence (-3151 Bayes Factors). This model was then tested against leniency (K= -9.1 dHart) and perceptual models (K= -7.1 dHart) suggesting a substantial finding against DRIFT, however, the tested models used a wide parameter, therefore, the possibility of a minor effect is not fully excluded.ConclusionDRIFT was not found; however, further studies with multiple centres and longer evaluations should be conducted.
02 Service provider views of the safety, appropriateness and perceived acceptability of telephone advice for calls to the ambulance service triaged as low urgency
Authors: Coster Joanne , Sampson Fiona C , O’Cathain Alicia , Nicholl Jon 
Published: August 2022

BackgroundHigh demand for ambulance care has led to changes in service provision, with calls identified as lower urgency increasingly being dealt with by telephone advice. A systematic review identified evidence of the feasibility of ambulance telephone advice but found little evidence around dimensions of quality e,g, safety This study uses interviews with service providers to explore the safety, appropriateness and acceptability of ambulance telephone advice.MethodsSemi-structured interviews were undertaken with 16 staff involved in the telephone advice process, including Call Handlers, Clinical Advisors and staff with a strategic service overview. Interviews were undertaken in one English ambulance service during the last quarter of 2020. Definitions of safety, appropriateness and acceptability were developed from a narrative review and applied to the interview findings. Interviews were analysed thematically using Framework.ResultsService provider interviews identified safety mechanisms at service, team and individual levels that enhance safety e.g. call auditing, clinical governance processes, multi-disciplinary Clinical Advisor team, and providing all calls with advice about what to do if a problem worsens. However, some staff perceived some gaps in service safety relating to under-triage, long waits for a clinical call back and concerns about the triage Concerns Process. Interviewees perceived telephone advice as mostly appropriate but identified mental health calls as very challenging for non-mental health specialists. Interviewees perceived user acceptability of telephone advice as mixed and linked to expectations around receiving an ambulance, whether the caller is reassured and length of time to receive a clinical call back.ConclusionsService providers perceived that telephone advice was mostly a safe and appropriate method of handling lower urgency calls. The introduction of mental health nurses to the Clinical Advice team was perceived as beneficial to the overall safety and appropriateness of mental health calls.
PP31 Airway management at adult out-of-hospital cardiac arrest: a survey of current UK ambulance service policy
Authors: Aljanoubi Mohammed , Brown Terry , Couper Keith , Fothergill Rachel , Perkins Gavin 
Published: August 2022

BackgroundOver 80% of the 30,000 out-of-hospital cardiac arrest (OHCA) patients treated in the UK each year receive advanced airway management (tracheal tube or supraglottic airway). Recent data from large randomised control trials have highlighted uncertainty regarding the clinical benefits of tracheal intubation and may have driven changes in ambulance service policy. We conducted a survey study to investigate the current UK ambulance service policy on the use of tracheal intubation during adult cardiac arrest.MethodsWe surveyed all UK ambulance services using an online survey platform to determine which staff groups are permitted to perform tracheal intubation and associated information linked to advanced airway management in adult cardiac arrest. A single representative of each ambulance service was requested to respond to the survey. The University of Warwick Biomedical & Scientific Research Ethics Committee provided ethical approval for the study.ResultsWe received survey responses from all 14 UK NHS ambulance services (response rate 100%).Five ambulance services (35.71%) do not permit non-specialist paramedics to perform tracheal intubation at adult out-of-hospital cardiac arrest. Of these services, the first service to withdraw tracheal intubation did so in 2010, whilst the remaining four did so from 2019 onwards. One further ambulance service stated they are currently in the process of withdrawing tracheal intubation.Of the five services that have withdrawn tracheal intubation, cited reasons for the policy change were challenges in providing ongoing training (n=5, 100%), results of clinical trials (n=4, 80%), clinical incidents of tracheal tube misplacement (n=4, 80%), and low tracheal intubation success rate (n=3, 60%).All 14 ambulance services (100%) reported that waveform capnography was available to ambulance crews.ConclusionThis study identified UK ambulance service policy variations concerning non-specialist paramedic use of tracheal intubation in adult cardiac arrest. The clinical impact of this variation requires further research.
PP34 Prehospital feedback & follow-up: a review of current practice in the United Kingdom
Authors: Wilson Caitlin , Janes Gillian , Lawton Rebecca , Benn Jonathan 
Published: August 2022

BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and researchers. The effectiveness of feedback in changing professional behaviour and improving clinical performance is strongly evidenced across a range of healthcare settings, but this has not yet been replicated within the prehospital context. Without a firmer evidence base, development in practice relies on isolated initiatives with no clear intervention model or evaluative framework. The aim of this study was to understand how UK ambulance services are currently meeting the challenge of providing prehospital feedback.MethodsThis was a national survey, which formed the first part of a realist evaluation of prehospital feedback. The survey used purposive and snowball sampling. It was advertised on social media and sent to prehospital feedback initiative leads identified through grey literature and networking (n=35). In addition n=8 NHS Ambulance Trusts formally supported this study and identified further initiatives (n=17). Data was analysed using content analysis.ResultsWe received responses from n=41 unique prehospital feedback initiatives, equating to a response rate of 79%. Of these n=27 were currently active. Responses were received from within 10 of the 13 NHS Ambulance Trusts in the UK. Initiatives most commonly provided individual patient outcome feedback to individual frontline ambulance staff members using email format, triggered by a request for feedback (i.e. a pull initiative). Common facilitators were engaged and responsive collaborators, with barriers being information governance and the time and resources involved.ConclusionsThis study suggests that the majority of UK Ambulance Trusts currently have examples of prehospital feedback initiatives within their footprint. In contrast with findings from a recent systematic review, there appear to be more initiatives providing individual patient outcome feedback than performance feedback. To further understand how prehospital feedback initiatives work, we will conduct in-depth case studies of 4 initiatives and develop a programme theory as part of our ongoing realist evaluation.
PP40 Could we identify the prehospital optimal shock energy for defibrillation? Answering the question that is POSED
Authors: Pocock Helen , Deakin Charles D , Lall Ranjit , Perkins Gavin D 
Published: August 2022

BackgroundDefibrillation of a shockable rhythm improves patients’ chance of survival following cardiac arrest. Evidence is limited regarding optimal shock energy level and delivery strategy. Most studies are based on old resuscitation regimes and use a variety of endpoints, making meaningful comparison difficult. The POSED study seeks to determine whether it is feasible to conduct a randomised, pragmatic clinical effectiveness trial in UK ambulance services to identify the optimal energy for defibrillation.MethodsThis is a pragmatic, cluster-randomised, open label, controlled trial. Defibrillators within a single UK Ambulance service will be randomised to one of three groups delivering shock strategies in current UK use. Adult (≥18 yrs) patients will be eligible if they sustain a cardiac arrest in the out-of-hospital environment that requires defibrillation. Defibrillators will be randomised to deliver one of the following strategies to 90 participants (30 in each group): 120-150-200J, 150-200-200J, 200-200-200J. Relatives of non-survivors of trial participation will be actively informed. Focus groups will explore the experiences of paramedics recruiting patients. The primary feasibility outcome is the proportion of eligible patients who received the randomised study intervention.ResultsBaseline variables will be reported. The secondary feasibility outcomes to be reported are the recruitment rate, rate of adherence to allocated treatment, data completeness of clinical outcomes and issues identified by ambulance staff with suggestions for study optimisation. Clinical outcomes are Return of an Organised Rhythm (ROOR) at 2 minutes post-shock, refibrillation rate, Return of Spontaneous Circulation (ROSC) at hospital handover, survival and neurological outcome at 30 days.ConclusionsThe POSED study will assess the feasibility and required sample size of a large-scale trial and will explore opportunities to optimise the trial protocol.
PP41 Simulated ambulance shifts using virtual reality: a service evaluation
Authors: Johnston Sasha , Strong Gary , Knowles Steve 
Published: August 2022

BackgroundOne of the consequences of delivering the frontline response during the COVID-19 pandemic has been the reduced capacity of UK Ambulance organisations to provide practical placement opportunities for undergraduate paramedic students. In lieu of traditional ambulance shifts, Virtual Reality (VR) can be used to simulate experiences without the student going through the real event. This service evaluation explores student feedback to understand whether VR technology could bridge the gap.MethodsFramed by the Plan, Do, Study, Act [PDSA] improvement cycle a series of VR simulated scenarios, related to mapped learning outcomes, supplemented practical ambulance placements for undergraduate paramedic students in south west England during the COVID-19 pandemic. Following simulated sessions, participating students were asked to voluntarily complete feedback questionnaires. Using Likert-scale questions, students were asked to rate the quality of tutors and the session content. Collated comments were entered into an Excel spreadsheet and content analysis was used to code and categorise responses based upon frequency.ResultsResults are based on eighty-eight nodes systematically generated from free-text feedback comments provided by fifty-three students who undertook a simulated practice placement utilising VR during April and May 2021. Nodes were reduced to fourteen categories and then condensed into nine themes relating to three domains of learning; affective, psychomotor and cognitive. An overarching theme of ‘enthusiasm for VR learning’ was identified.ConclusionsOverall, the utilisation of VR during simulated scenarios for undergraduate paramedic students appears to be a useful and acceptable adjunct to traditional ambulance shifts. The VR approach appears to be particularly useful for supporting the affective domain of learning with several students reporting increased self-confidence, positive interactions with course facilitators and the opportunity to put classroom knowledge into practice. We recommend that future use of VR should pay particular attention to the quality of simulations and the equipment used.
PP42 Perceptions and experiences of wellbeing provision for NHS ambulance staff: a qualitative interview study of wellbeing leads and frontline staff
Authors: Phung Viet-Hai , Pritchard Gary , Sanderson Kristy , Bell Fiona , Hird Kelly , Wankhade Paresh , Asghar Zahid , Siriwardena Niro 
Published: August 2022

BackgroundThe wellbeing of ambulance staff is critical to their safety and safe care delivery. This study examined the perceptions of English NHS ambulance Trust health and wellbeing leads, and the experiences of UK ambulance staff of workplace wellbeing culture and provision.MethodsSemi-structured telephone interviews were undertaken with staff wellbeing leads for eight NHS ambulance trusts in England and with ambulance staff from three NHS ambulance trusts in England, selected to represent services with high, medium or low relative sickness absence rates. Interviews were subsequently transcribed, coded and analysed using Framework Analysis (FA).ResultsWe interviewed eight wellbeing leads and 25 frontline ambulance staff from April-November 2020. Decisions around what was included in or omitted from wellbeing policies sometimes led to conflict between wellbeing leads and their superiors. Ambulance work was perceived as inherently unhealthy because of work stress and the risk of encountering traumatic incidents. Well-being leads understood the adverse impacts of work on mental health for some staff. Ambulance staff wanted empathy, understanding and practical support from managers, but the reality did not always match these needs, because of variability in provision and experiences of health and wellbeing services, poor behaviours or attitudes from line managers, and a stigmatising rather than open organisational culture. COVID-19 not only impacted significantly on staff health and wellbeing, but also challenged how ambulance trusts support them.ConclusionsThe importance of an open organisational culture and the variable availability and experiences of interventions to support staff to stay well at work means that improvements are needed in both to ensure positive staff mental health and wellbeing. Early interventions, improved training for line managers to support staff at work, bespoke wellbeing services and an open culture are key to delivering effective support to ambulance staff, especially in the light of the COVID-19 pandemic.
PP46 Paramedics in primary care: implementation matters
Authors: Kingston Mark , Porter Alison 
Published: August 2022

BackgroundPressures of patient demand and GP shortages have prompted a major workforce shift in primary care. Increasingly, paramedics are joining the primary care team but with wide variation in how they are employed, managed and supported. With numbers of paramedics in primary care rapidly increasing, evidence is needed to understand how PPC can be successfully implemented.MethodsWe evaluated two collaborative health board/ambulance service initiatives. Each featured advanced paramedics (APs) – paramedics with additional education - rotating between their usual role and the new primary care role. In site A, the service of 9 APs spanned 5 general practice clusters. Site B featured 1 general practice with 8 APs. We completed 28 qualitative interviews with APs, managers, practice staff, and patients to understand implementation at both sites. We used the iPARIHS implementation framework (Harvey and Kitson 2015) as a conceptual lens to analyse transcripts, applying its interrelated domains of context, innovation, recipients and facilitation.ResultsSite A was introduced as part of an innovation project, with external funding, a focus on training and personal development, and a structured lead in time. In site B paramedics were rapidly introduced to address an acute GP shortage, without formal training and support. The innovations were similar – home-visits and in-practice clinics undertaken by the practitioners. Interviewees (recipients) at both sites reported that the services helped to increase capacity, and were well received by patients and most staff. At site A: facilitation (by dedicated project workers) and training helped to shape the culture and preparedness. Site B APs and practice staff reported less readiness, impacting on morale, interprofessional working, and sustainability.ConclusionsParamedics increasingly feature in primary care, but there is great variation in service models and implementation. Our comparative approach, informed by iPARIHS, illustrates the importance of understanding implementation - alongside or in addition to effectiveness.
05 The RESearch PARamedic Experience (RESPARE) study
Authors: MClelland Graham , Charlton Karl , Limmer Matt 
Published: August 2022

BackgroundThe research paramedic is a relatively niche role undertaken by a small number of paramedics who support, deliver and promote research. Research paramedic positions are often temporary due to the project-based nature of studies. The routes into research, and how to establish a research career, are not as clear as routes into other areas of practice and very little has been published about the research paramedic role. The aim of this study was to explore the experience of people who work, or have worked, as research paramedics.MethodsA generic qualitative approach underpinned by phenomenological concepts was used. Participants were recruited via ambulance research leads and social media. Online focus groups allowed participants to discuss their roles with peers who may be geographically distant. Semi-structured interviews will expand on the focus group findings. Data were analysed using framework analysis.ResultsThirteen paramedics representing nine NHS trusts participated in three focus groups in November 2021.Initial themes include: common routes into the role; delivering versus developing research; barriers and facilitators to recruitment; networking and support; and clinical credibility.Five interviews are planned for December 2021 to expand on these findings.ConclusionsFurther analysis is needed but initial findings indicate that many research paramedics have had similar experiences in terms of starting by delivering research for large studies then building on this experience and the networks they create to develop their own research. There are recognised organisational and financial barriers to working as a research paramedic. Progression beyond the research paramedic role is not very well defined but often involves building links outside of the ambulance services.
OP09 The COVID-19 ambulance response assessment (CARA): measuring the psychological stress and preparedness of ambulance staff to deliver care during the first wave of the SARS-COV–2 pandemic in the UK in 2020
Authors: Barrett Jack , Williams Julia , Bennett-Eastley Kate , Owen Paul , Naeem Salman , Herbland Anthony , King James , Mortimer Craig 
Published: August 2022

BackgroundThe coronavirus infectious disease 2019 (COVID-19) places significant demand on the NHS. This study aimed to measure the preparedness of healthcare professionals working for ambulance services, in both direct-contact patient facing and remote roles, and the impact the COVID-19 pandemic had on their psychological stress and perceived ability to deliver care.MethodsClinicians working for NHS ambulance services were invited to participate in a three-phase sequential online survey during the acceleration phase of the first wave of COVID-19 in the UK. Participants who participated in the first survey and who consented to be re-contacted were asked to complete two further surveys during the peak and deceleration phases of the pandemic. Open and closed-ended questions were used to assess participants’ perceived preparedness in undertaking their clinical duties. In addition, the General Health Questionnaire-12 (GHQ-12) was utilised to measure participants’ anxiety, mood and general health through each phase of the study. A score greater than 12 indicates the participant may be experiencing psychological distress.ResultsPhase one recruited 3717 participants, reducing to 2709 (73%) by phase two and 2159 (58%) by phase three. Overall, mean GHQ-12 scores were 16.5 (± 5.2) during phase one, reducing to 15.2(±6.7) by phase three. Most participants were found to have a GHQ-12 score great than 12 during the first phase (n = 3112, 84%). Factors leading to higher mean GHQ-12 scores were feeling unprepared for the pandemic, a lack of confidence in both using personal protective equipment and managing out of hospital cardiac arrests in patients with confirmed or suspected COVID-19.ConclusionsA significant number of participants reported psychological distress, the reasons for which are multifactorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in delivery of unscheduled, emergency and urgent care under these additional pressures.