BackgroundPre-hospital research around the experience of transgender and non-binary (TNB) patients is scarce, with existing articles lacking input from TNB patients. This research aimed to collate TNB patients’ experiences of interacting with the ambulance service. A secondary aim was to gather TNB patients’ opinions regarding the education of ambulance clinicians on TNB health issues. MethodAn online-based, mixed-methods survey was created. A range of free text, multiple choice and Likert-scaled...
22h
ObjectiveThis study determined the impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics. MethodsThis was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The...
22h
BackgroundOpioids account for more fatalities by overdose than any other drug. Fatal opioid overdose is a growing public health problem, with incidence rising in western countries especially. We sought to describe the deaths, sociodemographic characteristics, and service usage patterns of decedents of opioid overdose in Wales. MethodsWe carried out a retrospective cross-sectional analysis of opioid related deaths in Wales identified from Office for National Statistics data between 01/01/2012 and...
22h
BackgroundThe participation of over 1500 study paramedics in AIRWAYS-2 provides a unique opportunity for an in depth exploration of how the views and practice of study paramedics, in advanced airway management, may have developed as a result of their participation in AIRWAYS-2, and how their experiences can inform future trials in out-of-hospital cardiac arrest (OHCA). Future prehospital guidelines and practice will not only be shaped by the results of large trials such as AIRWAYS-2, but also by...
22h
BackgroundNumbers of asylum seekers and refugees living in Wales have increased sharply. Many are liable to have unmet health needs and difficulty accessing services. We investigated the experience of, and access to, unplanned and emergency health services by asylum seekers, refugees and those refused asylum living in Wales. MethodWe surveyed 210 asylum seekers, refused asylum seekers and refugees and conducted eight focus groups with 57 participants (with interpreters present when necessary) to...
22h
ObjectiveTo characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit. MethodsWe performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter,...
22h
BackgroundIn recent years a number of Emergency Departments (EDs) in England have closed, or been replaced by a lower acuity facility such as an Urgent Care Centre. With further re-organisation of EDs expected, the ‘closED’ study aimed to provide research evidence to inform the public, NHS, and policymakers when considering future closures. Our aim was to understand the impact of ED closure on populations and emergency care providers, the first study to do so in England. In this session I will focus...
22h
ObjectiveWith the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity. MethodsWe conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important...
22h
ObjectivesAmbulance staff are increasingly required to make complex decisions as to whether they should convey a patient to hospital or ‘see and treat’ at the scene. Dementia can be a significant barrier to the assessment of pain and injury. However, to our knowledge no research has specifically examined the process of decision-making by ambulance staff in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during...
22h
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
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IntroductionParamedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. This study therefore aimed to describe the incidence and nature of cases attended by paramedics, the treatment provided, and the transport destination if transported, where the reason for attendance was associated with a history of palliative care. MethodsThis retrospective cohort study included...
22h
Background‘Closing the feedback loop’ is an important part of clinical reflective practice, but case feedback can be difficult for EMS staff to access. Our ‘Paramedic Postbox’ opened in July 2017, enabling paramedics to request case feedback directly from Emergency Department doctors. AimsTo review utilisation of our Postbox To assess user satisfaction and user–reported educational benefits of the feedback MethodThe first 12 months of feedback requests were analysed. User satisfaction data...
22h
BackgroundTrauma and obesity are both current global epidemics. A simple way to measure the body habitus of patients, to identify the overweight or obese is via the internationally recognized calculation of body mass index (BMI). The primary aim of this systematic review is to assess the mortality rate of those patients with a BMI > 30 kg/m2 in relation to traumatic injury and secondly to assess the effect of those patients with BMI > 30 kg/m2 upon the length of stay in hospital with regards...
22h
Addressing language barriers in the emergency departmentThe ‘Editor’s Choice’ paper covers the critical topic of communication and the concern that patients with a different first language are more likely to experience adverse events and poorer outcomes. How do you communicate with a patient who has a different first language: do you ask a member of the family to translate or a member of staff? Google translate? Attempt some rudimentary translation yourself? Or the recommended methods of using a...
22h
BackgroundAlcohol-related harms arising in the Night-Time Economy (NTE) impose a substantial burden on emergency services (ES) especially ambulance services engaged in both street level care and transportation of acutely intoxicated patients to a hospital Emergency Department (ED). Alcohol Intoxication Management Services (AIMS) are intended as an alternative care pathway for intoxicated patients who would normally use emergency services and are often run by ambulance services in partnership with...
22h
BackgroundFraming bias occurs when people make a decision based on the way the information is presented, as opposed to just on the facts themselves. How the diagnostician sees a problem may be strongly influenced by the way it is framed. Does framing bias result in clinically meaningful diagnostic error? MethodsWe created three hypothetical cases and asked consultants and registrars in Emergency Medicine and Internal Medicine to provide their differential diagnoses and investigations list. Two of...
22h
BackgroundFalls are frequent in older people and are the primary cause of injury in adults aged 65+. Falls are associated with high mortality, morbidity and immobility. Many people who fall become frequent fallers, increasing the risk of serious injury; subsequently falls prevention is an NHS priority. A new rapid response falls service comprising of a Paramedic and Occupational Therapist was launched on 30th November 2018 but no evidence exists to determine the clinical or cost effectiveness of...
22h
ObjectivesTo describe the incidence of pulmonary embolism (PE) in a critically ill UK major trauma centre (MTC) patient cohort. MethodsA retrospective, multidataset descriptive study of all trauma patients requiring admission to level 2 or 3 care in the East of England MTC from 1 November 2014 to 1 May 2017. Data describing demographics, the nature and extent of injuries, process of care, timing of PE prophylaxis, tranexamic acid (TXA) administration and CT scanner type were extracted from the Trauma...
22h
BackgroundThere is mounting evidence that post resuscitation care, should include early angiography and primary percutaneous coronary intervention (PPCI) in OHCA where a cardiac cause is suspected. In Yorkshire, the ambulance service can transport patients with a return of spontaneous circulation (ROSC), directly to a regional PPCI unit, if their ECG shows ST elevation myocardial infarction (STEMI) and the PPCI units accept. The aim of this study was to evaluate transport decisions, hospital characteristics...
22h
ObjectivesThe last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform...
22h
BackgroundOur previous work has shown that 35% of ambulance attendances by SCAS are to people aged 75 and over; 17% of these have dementia. The research literature suggests that older people with cognitive impairment/dementia experience longer stays, or die, in hospital. It is unclear whether factors such as call time or availability of social care impact conveyance rates. The aim of this study was to explore the impact of out-of-hours call-outs and social care provision on ambulance conveyance rates...
22h
A shortcut review was carried out to establish the incidence of arrhythmia after prescription of a fluoroquinolone antibiotic. 332 papers were found using the reported searches, of which 14 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that the incidence of arrhythmia after prescription of a fluoroquinolone antibiotic...
22h
BackgroundAmbulance service employees have high sickness absence rates compared to other National Health Service (NHS) occupations. The aim of this study was to understand factors linked to sickness absence in front-line ambulance service staff by determining whether there was an association between work and daily (non-work-related) stress, coping styles, demographic variables (health conditions, overtime hours, length of time in service, shift pattern, age and sex) and sickness absence. MethodsWe...
22h
BackgroundThe use of the 12-lead ECG is common in UK paramedic practice but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics. MethodsRegistered paramedics who attended the Emergency Services Show...
22h
BackgroundIn more than one-in-five cases of out-of-hospital cardiac arrest, the patient’s airway is soiled by vomit and blood. If a paramedic cannot clear the airway, the patient will die. A new method of clearing the airway called suction assisted laryngoscopy and airway decontamination (SALAD) has been developed, but it’s not known whether the method can assist paramedics to intubate. This study aims to determine whether paramedics can intubate a simulated soiled airway more often on their first...
22h
BackgroundContinuous positive airway pressure (CPAP) is not in widespread use in UK ambulance services, but could benefit patients with acute respiratory failure (ARF). As a new treatment in this context, clinician acceptability is an important factor in the feasibility of conducting definitive research in the prehospital arena. MethodsAs part of a pilot randomised controlled trial (the ACUTE study), nine trial-trained paramedics took part in three semi-structured focus groups. 204 trained staff...
22h
BackgroundDigital patient records in the ambulance service have opened up new opportunities for prehospital care. Previously it was demonstrated that prehospital pyrexia numbers are linked to an increase in overall calls to the ambulance service. This study aims to predict the future number of calls using deep-learning methods. MethodsTemperature readings for 280,447 patients were generously provided by the South Western Ambulance Service Trust. The data covered the time between 05/01/2016 and 30/04/2017...
22h
BackgroundFeedback and audit are ways of reflecting upon professional practice (Ivers et al, 2012). Opportunities for feedback have been cited as one of the mechanisms which ambulance staff develop their decision-making skills and reflect on their practice (Ivers et al, 2014). MethodsA digital patient outcome feedback intervention (POFI) was designed and tested. POFI reported patient outcomes, clinical investigations and treatment after conveyance to hospital. A data sharing agreement between one...
22h
PP16 Prehospital recognition and antibiotics for 999 patients with sepsis: feasibility study results
BackgroundSepsis is a common condition which kills approximately 44,000 people annually in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve outcomes. Paramedics frequently attend patients with sepsis, and are well placed to provide early diagnosis and treatment. We aimed to assess whether a multi-centre randomised trial to evaluate pre-hospital antibiotics was feasible. MethodsVolunteer paramedics used scratchcards to allocate patients with ‘Red Flag’...
22h
BackgroundThe introduction of information technology (IT) in emergency ambulance services to electronically capture, interpret and store patient data can support out of hospital care. Although electronic health records (EHR) in ambulances and other digital technology are encouraged by national policy across the UK, there is considerable variation across services in terms of implementation. We aimed to understand how electronic records can be most effectively implemented in a pre-hospital context,...
22h
BackgroundIn response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have recently been introduced with various configuration, employment and governance arrangements, but we do not know the risks and benefits of Paramedics working in Primary Care (PPC),...
22h
Benda et al found that in an emergency department in the eastern United States, Spanish-speaking patients who needed language assistance received inconsistent and often non-recommended language access services across different phases of patient care.1 These ranged from emergency department staff speaking English to the patient, the provider speaking Spanish (with varying levels of proficiency) or the use of either professional or ad hoc interpreters. What happens in the hospital investigated in their...
22h
BackgroundDiabetes, which affects over 1 in 5 nursing or care home residents, may lead to diabetes-related emergencies with ambulance call-outs and hospitalisation. Our aim was to investigate the epidemiology of diabetes-related emergencies in care home residents which involved an ambulance attendance. MethodsWe used a cross-sectional design to investigate emergency ambulance attendances to people in nursing and residential care homes presenting with diabetes-related emergencies across the East...
22h
Clinical IntroductionAn 81-year-old man with a history of hypertension and hyperlipidemia presented with epigastric pain for 3 days, which was associated with skin yellowing and vomiting. There were neither fever, diarrhoea, tea-coloured urine nor the consumption of traditional Chinese medicine or raw seafood. Examination showed jaundice and right upper quadrant tenderness. Chest X-ray and ECG were unremarkable. Urine dipstick test was 1+ for bilirubin. QuestionWhat is the diagnosis?Acute calculous...
22h
BackgroundThe pre-hospital 12-lead electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found PHECG was associated with improved 30-day survival, but a third of ACS patients under EMS care did not have PHECG. Such patients tended to be female, older and/or with comorbidities. This previous study was undertaken when thrombolytic treatment was the main treatment for ST segment elevation myocardial...
22h
Case presentationA 5-day-old boy presented to the ED with 1 day of red tinted diapers (figure 1). The child was born at 39 weeks without major complications, received all medications/vaccinations after birth and had passed meconium normally. He was eating well and acting normally according to his mother. She expressed concern that he may have blood in his diaper, because she saw redness that she had not ever seen before. Physical exam was normal. He was breast fed twice in the ED and was ultimately...
22h
PP20 A retrospective service evaluation of the presentation of anaphylaxis to a UK ambulance service
BackgroundThere is a lack of data relating to frequency and presentation of anaphylaxis to the ambulance service in England. Little research exists relating to the patients’ self-treatment of anaphylaxis and there is an absence of evidence to evaluate the impact of self-administered adrenaline, there is a need to describe this patient group to evaluate any potential to develop their care. MethodsRetrospective data were collected from the electronic patient records of a single NHS ambulance service...
22h
ObjectivesChest pain is among the leading causes for emergency medical services (EMS) activation. Acute myocardial infarction (MI) is not only one of the most critical aetiologies of chest pain, but also one of few conditions encountered by EMS that has been shown to follow a circadian pattern. Understanding the diurnal relationship between the inflow of chest pain patients and the likelihood of acute MI may inform prehospital and emergency department (ED) healthcare providers regarding the prediction,...
22h
PP21 Non-technical skills in the out-of-hospital cardiac arrest - identification for future practice
BackgroundThe use and assessment of non-technical skills (NTS) in healthcare has gained recognition in recent years. Mainly adopted from aviation key NTS have enabled specific teams such as surgical and anaesthetics, to improve leadership, communication and situational awareness. Paramedic NTS have been identified but in the out-of-hospital cardiac arrest (OHCA) there is limited evidence. This study aims to identify NTS in the OHCA to inform the design of an assessment tool to improve overall management...
22h
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