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British Paramedic Journal Jun 2024Intravenous thrombolysis and mechanical thrombectomy are effective time-sensitive treatments for selected cases of acute ischaemic stroke. While thrombolysis is widely...
INTRODUCTION
Intravenous thrombolysis and mechanical thrombectomy are effective time-sensitive treatments for selected cases of acute ischaemic stroke. While thrombolysis is widely available, thrombectomy can only be provided at facilities with the necessary equipment and interventionists. Suitable patients admitted to other hospitals require secondary transfer, causing delays to treatment. Pre-hospital ambulance redirection to thrombectomy facilities may improve access but treatment eligibility cannot be confirmed pre-hospital. Some redirected patients would travel further and be displaced without receiving thrombectomy. This study aimed to elicit stroke survivor and carer/relative views about the possible consequences of introducing a conceptual, idealised ambulance redirection pathway.
METHODS
Focus groups were undertaken using a topic guide describing four hypothetical ambulance redirection scenarios and their possible consequences: earlier treatment with thrombectomy; delayed diagnosis of non-stroke 'mimic' conditions; delayed thrombolysis treatment; and delayed diagnosis of haemorrhagic stroke. Meetings were audio recorded, transcribed verbatim and data analysed thematically using emergent coding.
RESULTS
Fifteen stroke survivors and carers/relatives participated in three focus groups. There was wide acceptance of possible low-risk consequences of ambulance redirection, including extended travel time, being further from home and experiencing longer hospital stays. Participants were more uncertain about higher-risk consequences, including delays in diagnosis/treatment for patients unsuitable for thrombectomy, but remained positive about ambulance redirection overall. Participants rationalised acceptance of higher-risk consequences by recognising that redirected patients would still access appropriate treatment, even if delayed. In addition, acceptance of ambulance redirection would be increased if there were robust clinical evidence showing net benefit over secondary transfer pathways.
CONCLUSIONS
Participant views were generally supportive of ambulance redirection to facilitate access to thrombectomy. Further research is needed to demonstrate overall benefit in an NHS context.
PubMed: 38946738
DOI: 10.29045/14784726.2024.6.9.1.1 -
British Paramedic Journal Jun 2024Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an...
BACKGROUND
Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed.
OBJECTIVES
This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care.
METHODS
The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework.
RESULTS
The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols.
CONCLUSIONS
Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.
PubMed: 38946737
DOI: 10.29045/14784726.2024.6.9.1.47 -
British Paramedic Journal Jun 2024The Calgary-Cambridge Model (C-CM), developed by Kurtz and Silverman in 1996, is a communication tool developed for doctors. Since its publication, it has been adopted...
INTRODUCTION
The Calgary-Cambridge Model (C-CM), developed by Kurtz and Silverman in 1996, is a communication tool developed for doctors. Since its publication, it has been adopted by various healthcare professionals; however, no previous research has been identified that evaluates its use in paramedic practice. This study aims to explore the experience of students and newly qualified paramedics (NQPs) applying the C-CM in practice, and establish their experiences and perceptions of its suitability as a communication tool in the pre-hospital environment.
METHODS
This MSc research project, conducted in April-May 2021, applied qualitative methods with thematic analysis to written reflections and semi-structured interview transcripts discussing the implementation of C-CM in paramedic practice. A convenience-quota sample of 11 participants, consisting of third-year paramedic students and recent NQPs, were recruited. This research is reported using Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines.
RESULTS
Eleven participants were recruited in total; nine consented to reflective writing analysis and interviews, two consented to writing analysis only. Analysis of the writing samples allowed for a deductive approach to the interview plan. Participants consisted of seven males and four females. All eleven participants (ten British and one Indian) spoke English as a first language. Ages ranged from 18 to 59 years. Career status was 46.2% third-year students and 53.8% NQPs. Four major themes were identified: barriers to implementation of the C-CM in practice; impact of C-CM on paramedic practice; C-CM as a teaching and learning tool in paramedic practice; and adaptation of C-CM for paramedic practice.
CONCLUSIONS
Participants suggested that implementation of C-CM leads to improved structure and shared decision-making; however, adaptions to make it more paramedic-focused would be welcomed. The diversity of patients and their preferences can make its implementation challenging, and the negative feedback received from experienced ambulance staff was a significant concern to participants.
PubMed: 38946736
DOI: 10.29045/14784726.2024.6.9.1.23 -
British Paramedic Journal Jun 2024Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of...
INTRODUCTION
Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making.
METHODS
We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool's purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users.
RESULTS
The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups.
CONCLUSIONS
This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.
PubMed: 38946735
DOI: 10.29045/14784726.2024.6.9.1.10 -
British Paramedic Journal Jun 2024Ambulance personnel are exposed to traumatic and stressful situations, which can increase the risk of mental health conditions, such as post-traumatic stress disorder...
INTRODUCTION
Ambulance personnel are exposed to traumatic and stressful situations, which can increase the risk of mental health conditions, such as post-traumatic stress disorder (PTSD). High rates of PTSD have been found in ambulance personnel (Petrie et al., 2018), but no review is available to examine post-traumatic growth (PTG - positive psychological change following a trauma) in this population. This literature review provides an overview of the prevalence rates and facilitators that may contribute to PTG in ambulance personnel.
METHODS
A systematic search was conducted on EBSCOhost in January 2024 across the following six databases: Academic Search Ultimate, PsycINFO, PsycARTICLES, MEDLINE, ERIC and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate.
RESULTS
Eleven papers were identified for this review. Pooled prevalence of PTG was moderate (52%), and facilitators for PTG were grouped into five categories: coping style/strategies, resilience, personality traits, gender and incident characteristics.
CONCLUSIONS
Numerous facilitators contributed to the development of PTG, although these did not arise in all papers. The quality of research ranged from satisfactory to excellent. Evidence suggested that adaptive coping style, high levels of resilience, the absence of a personality trait (neuroticism) and being female may facilitate PTG. Further research is needed to support the reliability of findings.
PubMed: 38946734
DOI: 10.29045/14784726.2024.6.9.1.34 -
Public Health Nursing (Boston, Mass.) Jul 2024The aim of this study was to evaluate the psychosocial difficulties and life experiences of nurses working in the disaster area following the earthquake on February 6,...
AIM AND OBJECTIVES
The aim of this study was to evaluate the psychosocial difficulties and life experiences of nurses working in the disaster area following the earthquake on February 6, Kahramanmaraş centered earthquake with a phenomenological approach.
BACKGROUND
After natural disasters such as earthquakes, nurses play a significant role in providing both physical and psychosocial support. Therefore, the experiences of nurses in this field are necessary both to support them and to assist disaster survivors.
MATERIALS AND METHODS
In this study, in which the phenomenological research method was used, semi-structured in-depth interviews with 18 nurses who provided health care services during the February 6 Kahramanmaraş earthquake were conducted between January and February 2024 via Whatsapp mobile application. Snowball sampling method was used to reach the sample group. Interviews continued until data saturation was achieved. All interviews were audio recorded and then transcribed. The data were analyzed using thematic analysis. The study was conducted and reported according to the COREQ checklist.
RESULTS
Data analysis revealed two themes (psychological and social difficulties caused by the earthquake, traumatic stress and coping experiences as a nurse) and five sub-themes (social difficulties, psychological difficulties, traumatic events, reactions and coping).
CONCLUSION
As a result of the study, it was determined that nurses providing health care services were negatively affected psychosocially by the traumatic stress situations they experienced in the earthquake centered in Kahramanmaraş on February 6. It was determined that nurses had great difficulty in coping with the traumatic stress situations they experienced. It was concluded that the February 6 earthquake caused secondary traumatization in nurses.
PubMed: 38946476
DOI: 10.1111/phn.13369 -
European Heart Journal Jun 2024Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology...
Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology demand a disease-tailored approach. In both conditions, fast treatment plays a crucial role as ischaemia and eventually infarction develop rapidly. Furthermore, in both fields, the introduction of fibrinolytic treatments historically preceded the implementation of endovascular techniques. However, in contrast to STEMI, only a minority of AIS patients will eventually be considered eligible for reperfusion treatment. Non-invasive cerebral imaging always precedes cerebral angiography and thrombectomy, whereas coronary angiography is not routinely preceded by non-invasive cardiac imaging in patients with STEMI. In the late or unknown time window, the presence of specific patterns on brain imaging may help identify AIS patients who benefit most from reperfusion treatment. For STEMI, a uniform time window for reperfusion up to 12 h after symptom onset, based on old placebo-controlled trials, is still recommended in guidelines and generally applied. Bridging fibrinolysis preceding endovascular treatment still remains the mainstay of reperfusion treatment in AIS, while primary percutaneous coronary intervention is the strategy of choice in STEMI. Shortening ischaemic times by fine-tuning collaboration networks between ambulances, community hospitals, and tertiary care hospitals, optimizing bridging fibrinolysis, and reducing ischaemia-reperfusion injury are important topics for further research. The aim of this review is to provide insights into the common as well as diverging pathophysiology behind current reperfusion strategies and to explore new ways to enhance their clinical benefit.
PubMed: 38941344
DOI: 10.1093/eurheartj/ehae371 -
Journal of Primary Health Care Jun 2024Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences...
Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.
Topics: Humans; Native Hawaiian or Other Pacific Islander; Male; Female; New Zealand; Middle Aged; Emergency Medical Services; Qualitative Research; Adult; Cultural Competency; Health Services Accessibility; Allied Health Personnel; Interviews as Topic; Aged; Cardiovascular Diseases; Paramedics; Maori People
PubMed: 38941254
DOI: 10.1071/HC24010 -
Pre-hospital evaluation of chest pain patients using the modified HEART-score: rationale and design.Future Cardiology Jun 2024This study assesses how ambulance paramedics using the modified HEART-score with a point-of-care cardiac troponin (cTn) compare to the emergency physicians using the...
This study assesses how ambulance paramedics using the modified HEART-score with a point-of-care cardiac troponin (cTn) compare to the emergency physicians using the modified HEART-score with a high-sensitive cTn (hs-cTn) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS), focusing on interobserver agreement and diagnostic performance. In this prospective multicenter cohort, we compare four cTn testing strategies (serial point of care and hs-cTn cTn measurement) with and without the HEART-score. Outcomes include the HEART-score's interobserver agreement, NSTE-ACS at discharge, major adverse cardiovascular events (MACE) after 30 days, and diagnostic accuracy of the different strategies. The POPular HEART study aims to improve NSTE-ACS diagnostic pathways, promoting pre-hospital detection and ruling out of NSTE-ACS to minimize unnecessary hospitalizations and associated costs. NCT04851418 (ClinicalTrials.gov).
PubMed: 38940186
DOI: 10.1080/14796678.2024.2356995 -
Acta Anaesthesiologica Scandinavica Jun 2024In the field of prehospital emergency medicine, specialized emergency medical service (EMS) providers interact with acutely ill patients and their relatives. The...
BACKGROUND
In the field of prehospital emergency medicine, specialized emergency medical service (EMS) providers interact with acutely ill patients and their relatives. The influence of family presence during in-hospital resuscitation is well described. However, no studies have previously assessed the influence of relatives' presence in the acute prehospital setting. The aim of this study was to investigate EMS providers' perspectives on relatives' impact on the acute prehospital treatment of adult patients.
METHODS
An online anonymous survey was distributed to all prehospital EMS providers in the Capital Region of Denmark. The survey included 25 research questions on a 5-point Likert scale, investigating relatives' influence on treatment in three different domains: positive, negative, and resuscitation. A higher domain score indicates a high level of agreement or frequency.
RESULTS
Two hundred forty-six EMS providers completed the survey (84 ambulance technicians, 87 paramedics, and 75 physicians). There were no significant differences in the positive domain across professions (p = .175). Physicians had a statistically significant lower median score in the negative domain, compared with ambulance technicians and paramedics (2.50 vs. 2.63 and 2.63, p = .024). In the resuscitation domain, paramedics and physicians had a significant lower median score compared with ambulance technicians (3.00 and 3.00 vs. 3.14, p = .003).
CONCLUSION
All professions were equally positive towards the relatives' presence and involvement in the acute prehospital setting. Physicians were less likely to be negatively influenced by the presence of relatives compared with ambulance technicians and paramedics. In all professions, increased experience led to improved comfort with handling relatives.
PubMed: 38937943
DOI: 10.1111/aas.14480