British paramedic journal最新文献

Introduction: Vitamin D deficiency can impact health and well-being and may affect workplace performance. Shift, indoor and night working, alongside variable awareness of vitamin D, likely puts ambulance staff at an increased risk of deficiency. Screening in one ambulance service detected that 46% of staff had insufficient or deficient vitamin D levels (i.e. 50.0 nmol/L or less, as defined by NICE). The aim of the EVOLVED study was to explore the behaviours and lifestyle factors of ambulance service staff with a range of vitamin D levels and understand the impacts on their work and personal lives.

Methods: A purposive sample of 40 ambulance staff was recruited over four months and invited to a one-hour online semi-structured interview. Interviews explored behaviours and lifestyle factors of those above and below the recommended adequate vitamin D levels and included questions about the impacts of vitamin D level on personal and professional well-being, with the opportunity to suggest possible improvements. Interview transcription analysis was undertaken using an intuitive thematic analysis strategy.

Results: Participants were aged between 21 and 69 years and worked in varying roles, including control room (n = 9), operational (n = 20) and support staff (n = 11) and included those from diverse ethnic backgrounds to represent Trust demographics. Five themes were identified: reaction to result; diet; deficiency symptoms and impacts; impact of work on maintaining adequate vitamin D levels; and activity levels.

Conclusion: A lack of awareness of vitamin D-related issues was identified, alongside a variety of improvement suggestions, including participants emphasising the importance of awareness, to allow staff to take responsibility to promote their own health and well-being. Strategies to promote awareness of vitamin D should be considered to improve staff well-being in this area. Participants positively perceived research exploring staff health and well-being, highlighting this as an area for future research.

Introduction: Simulation-based learning (SBL) is a recognised teaching and learning tool within higher education (HE) and one capable of facilitating skill retention and knowledge retrieval. Successfully achieving these outcomes relies on effective design, delivery and debriefing; yet a limited range of publications draw together these fundamental components. High-fidelity simulation (HFS) describes a sub-division of SBL that, in recent years, has generated traction within healthcare education.

Aims: To support educators in orchestrating HFS with greater impact and influence, the author set out to compose an article outlining five constructs that collectively possess scope to optimise HE teaching and learning outcomes. These five constructs consist of: (1) creating a believable scenario; (2) integrating the five principles of 'fidelity harmony'; (3) selecting an appropriate modality; (4) adopting a clear pedagogical stance; and (5) amalgamating concepts of experiential learning theory into the briefing and debriefing. When dynamically incorporated, important gaps between theory and practice can be bridged and learner experience will be significantly enhanced.

Conclusion: This article offers HE educators a series of recommendations for creating deeply immersive learning experiences for augmenting learner performance, and provides a new definition for HFS, which challenges the erroneous notion that 'high fidelity' represents 'high technology'.

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality in the UK, with survival rates remaining low despite advancements in resuscitation techniques. The European Resuscitation Council and Resuscitation Council UK guidelines recommend controlled ventilation during cardiopulmonary resuscitation (CPR), yet studies show that ambulance clinicians often fail to meet these standards. In particular, hyperventilation has been linked to worse outcomes. This protocol describes a study that will explore the impact of different applications of real-time ventilation feedback on the quality of ventilations during CPR in a simulated environment.

Methods: This exploratory simulation study will assess the effectiveness of real-time feedback on the quality of ventilations delivered by ambulance clinicians. Participants from North East NHS Foundation Trust will be randomly assigned to three arms, receiving a single episode of feedback, regular feedback or no feedback (used as a control group). Each arm will complete four simulated OHCA scenarios over six months, and their ventilation quality will be assessed at each session. The primary outcome will be the quality of ventilations, measured by rate and tidal volume, at the six-month mark. Secondary outcomes include trends in ventilation quality over time and participant characteristics.

Discussion: This study aims to explore whether regular feedback improves the quality of ventilations during CPR and whether feedback sessions influence skill retention over a six-month period. Findings could inform training strategies, highlighting the role of real-time feedback in maintaining high-quality CPR skills. With a lack of prior research on ventilation skill maintenance in the UK, this study is expected to provide valuable insights into optimising clinical performance.

Introduction: Chest pain is one of the most common conditions presenting to emergency departments (EDs), with over 1.3 million attendances according to 2022/2023 UK data. The diagnosis of a myocardial infarction (MI) in pre-hospital settings is challenging, relying on careful history taking and electrocardiograms. Patients with ST elevation are transferred to hospitals with primary percutaneous coronary intervention (PPCI) facilities, whereas those without ST elevation are taken to local EDs for further work-up, including troponin testing. Point-of-care (POC) troponin tests are now available in the field, presenting the potential to diagnose MI in patients without ST elevation. This systematic review aims to investigate and determine whether POC troponin devices are effective in detecting patients with acute MI in the pre-hospital setting.

Methods: This systematic review was performed in accordance with the PRISMA guidelines. A comprehensive search of the literature was created using the following databases: CINAHL, MEDLINE, EMBASE and DISCOVERY. Basic and advanced search strategies were used to identify papers using POC troponin testing in patients presenting in the pre-hospital setting with chest pain.

Results: A total of five articles were identified demonstrating that a variety of pre-hospital POC troponin testing devices can detect MI in patients presenting with chest pain. One limitation of POC testing was that some patients with negative troponin results in the pre-hospital setting were confirmed to have MI in the hospital setting.

Conclusion: Using POC troponin raises the possibility of detecting an MI, but cannot definitively exclude an MI. Further research is required to investigate the reliability of POC troponin testing in cohorts without ST elevation in the pre-hospital environment, which may expedite transfer to specialised PPCI hospitals over a local ED. The outcome of further research has the potential to positively impact outcomes of patients suffering with MI and to yield financial benefits via faster, more effective treatment.

Introduction: In the United Kingdom, ambulance services attempt resuscitation on 30,000 people per year, with fewer than 9% surviving and leaving hospital. Correct ventilation during out-of-hospital cardiac arrest (OHCA) is essential, as both hypo- and hyperventilation are linked to increased mortality. Despite this, ventilations are frequently given outside of recommended guidelines. Devices providing real-time feedback on ventilations aim to improve performance. While systematic reviews show that real-time feedback devices improve chest compression performance, evidence regarding ventilation feedback devices (VFDs) has not yet been synthesised. This literature review aimed to synthesise evidence on the effects of VFDs in OHCAs.

Methods: Databases searched in March 2025 included MEDLINE, CINAHL and Embase. Inclusion criteria were papers published after 1 January 2018, in English, involving adults, focused on clinical practice or simulated OHCA and employing primary research with interventional study designs. The intervention criteria required a VFD that measured and provided feedback on both tidal volume and ventilation rate. Study quality was assessed using the Critical Appraisal Skills Programme checklist. Methods for synthesis included a narrative summary of findings.

Results: The searches yielded 793 results. Nine studies met the inclusion criteria: seven simulation studies and two real-world studies. Simulation studies confirmed that ambulance clinicians often did not meet advanced life support guidelines for ventilations. Introducing VFDs significantly improved compliance, accuracy and precision of delivered ventilations in simulated OHCA scenarios. Real-world studies found an increase in ventilation compliance; however, the study examining patient outcomes was of low quality and did not find a statistically significant effect.

Conclusion: The evidence suggests that VFDs are beneficial in simulated OHCA. Real-world studies suggest that the increase in ventilation performance may not be as significant as shown in simulation studies, and their effect on clinical outcomes has not yet been adequately explored.

Introduction: 'Deaths of despair' (DoD) - encompassing fatalities from suicide, drug overdoses and alcohol-related causes - represent a growing public health crisis. Socioeconomic vulnerability and healthcare disparities are well-documented drivers of DoD. While healthcare contacts preceding despair-related deaths have been studied extensively, the role of ambulance services is underexplored. This study aimed to address this gap by utilising ambulance service data to provide insights into 'calls of despair' received by a UK ambulance service over a 12-month period.

Methods: This exploratory, retrospective study analysed data collected during 2023 by Yorkshire Ambulance Service (YAS), which serves urban and rural areas with varying levels of deprivation. Calls were included if they involved suicidal ideation and/or drug or alcohol misuse. Data were sourced from computer-aided dispatch and electronic patient records and were analysed to describe call characteristics, demographic profiles, geographical distribution, temporal trends and repeat caller patterns.

Results: In 2023 YAS received 40,870 calls of despair. Nearly half of those calls originated from the most deprived quintile. Urban areas had more than double the rate of calls compared to rural areas. More than half (54%) of the calls involved drug and alcohol misuse, while 43% were related to suicidal ideation. Females were more likely to call for substance misuse (58%) than suicide (46%), and young females (<25 years) represented a disproportionate share of calls. Only 43% of calls resulted in hospital conveyance, suggesting ambulance services capture crises that are not reflected in hospital datasets. Repeat callers were common, with 119 individuals making more than 10 calls each.

Conclusion: The findings highlight the utility of ambulance service data in understanding despair-related crises, particularly among socioeconomically disadvantaged and young populations. Ambulance data offers a valuable lens for public health monitoring, capturing acute needs often absent in traditional healthcare datasets. These insights emphasise the need for targeted interventions and cross-sectoral approaches to address the underlying drivers of despair.

Introduction: Unplanned pre-hospital births present one of the most challenging and complex incidents for ambulance personnel to attend. This rapid review aimed to consider the barriers to providing effective maternity care in the emergency pre-hospital setting.

Methods: A rapid evidence review was performed using Medline and Cumulated Index to Nursing and Allied Health Literature Complete on studies dating between 2000 and 2024. A critical appraisal and thematic synthesis were also carried out. Qualitative studies written in English that considered staff and patient perspectives for pre-hospital maternity care were eligible for inclusion in this review.

Results: Six studies were identified, and three analytical themes were generated: intrinsic, extrinsic and non-technical factors impacting obstetric care. Most ambulance clinicians felt insufficiently prepared for unplanned pre-hospital childbirth. Undergraduate-level training and continuing professional development opportunities were considered poor and were acknowledged as areas requiring improvement. Academic and ambulance service organisations should work towards addressing clinicians' lack of exposure to and confidence with maternity incidents.

Conclusion: Without regulatory and organisational input, unplanned pre-hospital births will continue to challenge both newly qualified and seasoned ambulance clinicians. There is an inherent need for revised maternity training standards for pre-hospital personnel that aims to address the barriers identified within this review paper. To set forth a provision of multidisciplinary and collaborative education opportunities, pre-hospital clinicians need to be acknowledged as key care providers for pregnant women in the emergency setting.

Introduction: The return of spontaneous circulation (ROSC) care bundle is a set of interventions designed by NHS England for use in the post-resuscitation care of patients following out-of-hospital cardiac arrest (OHCA). Compliance with these standards is critical in providing optimal, standardised care and in improving outcomes. This study aimed to investigate the impact of critical care paramedics (CCPs) on delivery of post-ROSC care.

Methods: A retrospective observational study was conducted across a large UK ambulance service. All patients with sustained ROSC following resuscitation for OHCA over a one-year period were included. The post-ROSC care delivered to two groups was compared - a standard care group, and a group where a CCP was present.

Results: The study included 997 incidents: 106 incidents in the non-CCP group and 891 incidents in the CCP group. The presence of a CCP was associated with a statistically significant increase in compliance with the ROSC bundle. Of incidents with a CCP present, 75% were fully compliant, compared with 64% of incidents without a CCP. The mean percentage compliance across the standards was significantly higher in the CCP group. Secondary outcome analysis showed statistically significant benefits in compliance for several care parameters when a CCP was present.

Conclusion: This retrospective study confirms that the presence of a CCP improves delivery of post-ROSC care. This highlights the potential benefits of having CCPs as part of the standard pre-hospital care resuscitation team. Further research is needed to confirm these findings and to examine the relationship between the ROSC bundle and patient outcomes.