Emergency Medicine Journal最新文献

Background: Cardiopulmonary resuscitation (CPR) is often not initiated promptly enough in out-of-hospital cardiac arrest, even when call-handlers provide instructions. Identifying the critical, potentially modifiable, barriers to CPR is essential. Our aim was to identify factors associated with delays (1) positioning patient flat and (2) initiating CPR in recordings of cardiac arrest calls and to explore potentially modifiable behavioural factors.

Methods: Retrospective analysis of 200 call recordings to the Scottish Ambulance Service January 2019-December 2020 during which dispatcher-assisted CPR instructions were provided. Potential barriers were coded inductively. Log rank tests were used to explore differences in 'time to position patient flat' and 'time to initiate CPR' depending on the presence/absence of potential barriers identified.

Results: A random sample of 200 calls were selected from 11 275 potentially eligible calls. Patients in those calls were mostly male (61%), most aged 40-80s; callers were mostly female spouses. Time to position patient flat: median 40 s (IQR: 15.5-82.0), time to initiate CPR: median 50 s (IQR: 36-92). Between 1 and 11 potential barriers were identified in calls (median=4, IQR:2-6).The most common barriers identified were communication (48%), emotion (45.5%) and physical challenges (38.5%). Various physical challenges, concern patient too heavy, concern that it was too late/futile, concern about physical ability, concern about doing harm and caller being 'upset' were significantly associated with delays to positioning the patient flat. Callers 'not knowing how' to do CPR; expressing concerns about doing harm, expressing anger and various physical challenges including concerns about ability were associated with delays in initiating CPR. Many significant barriers are potentially amenable to behavioural techniques.

Conclusion: Barriers to 'positioning the patient flat' and 'initiating CPR' are not the same. Concerns vary, and so identifying and addressing the specific concerns for individual callers at each stage might facilitate earlier CPR. Many of the issues delaying CPR are potentially modifiable with behavioural techniques.

Background: Procedural sedation is routinely provided for children in the emergency care setting. However, there are still significant gaps in knowledge regarding the optimal provision of sedation for children who are undergoing painful and/or distressing procedures. We aimed to develop a prioritised research agenda that identifies key questions for paediatric procedural sedation in the emergency care setting that will guide future research and optimise care for children.

Methods: We used a modified Delphi approach to achieve consensus among a multidisciplinary and geographically diverse expert advisory group. An initial list of 42 research questions was identified, with successive rounds of questionnaires conducted until there was a convergence of opinion or a point of diminishing returns was reached. The list was iteratively refined each round by advisory group members who ranked research questions and were given the opportunity to provide suggestions for potential additional questions and provide feedback regarding questions considered.

Results: 54 advisory group members participated in the modified Delphi approach. Over the course of two rounds, we identified 10 research questions as the highest priority for future investigation. These questions included topics addressing short- and long-term outcomes related to inadequate assessment and provision of sedation, patient-centered and family-centered outcomes, validity and reliability of clinically important outcome measures, most effective sedative regimens for children undergoing painful procedures, most effective sedative regimens for children undergoing non-painful procedures, most effective sedatives for minimal sedation/anxiolysis, effectiveness of novel sedation approaches, eliminating health disparities, clinician education and competency and the use of simulation to improve sedation outcomes.

Conclusions: The 10 research questions identified as highest priority can inform future work by researchers, funders, policymakers and other key decision makers who aim to meaningfully advance the provision of procedural sedation for children cared for in the emergency care setting.

Mental health presentations represent a significant proportion of attendances to UK emergency departments, but the experiences of patients presenting with mental health issues are reportedly poor. A new model called EmPATH (Emergency Psychiatric Assessment, Treatment and Healing) has been developed in the USA as a means of providing more patient-centred care to this vulnerable group, to the benefit of both service users and healthcare systems. It has been shown to provide a safe space for those most in need, shorten emergency department stays and reduce inpatient admissions. This paper introduces the EmPATH model, discusses potential challenges to its implementation in the UK setting and proposes that the principles of EmPATH could be combined with novel research to develop UK-specific solutions.

The 'tea trolley training' model is well described and established in hospital medical education, but, to the authors' knowledge, has not previously been used for training in the prehospital environment. We sought to adapt this workplace-based teaching approach to improve intraosseous (IO) knowledge, confidence and morale among ambulance clinicians, without adversely affecting operational performance.A mobile 'tea trolley' containing IO equipment, task trainers and refreshments was taken to two emergency department ambulance bays on separate days. Short teaching sessions were delivered opportunistically to prehospital clinicians by a critical care team. An anonymised QR-code survey captured role, self-reported impact on knowledge, confidence, morale and inter-professional working.62 clinicians responded (including paramedics, emergency care assistants and technicians). Most reported improved IO skills and knowledge (94%, n=58), with the remainder neutral. All respondents felt the format worked well and would attend future sessions. Almost all (98%, 61/62) reported improved morale, and all felt that regular tea trolley training would enhance collaborative working between the ambulance service and local air ambulance. No adverse impact on turnaround times was reported.Adapting tea trolley training to the prehospital setting is feasible, well received and perceived to improve IO competence, morale and collaborative working, without compromising operational resilience.