emergency services current awareness update - issue 24, may to august 2014

8/11/2019 Emergency Services Current Awareness Update - Issue 24, May to August 2014

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Prehospital Emergency Services - Current Awareness Update Issue 24, May to August 2014

Prehospital Emergency Services

Current Awareness UpdateIssue 24, May to August 2014

Welcome to Issue 24of the Prehospital Emergency Services Current Awareness Update.

In this issue:

Whats New

Prehospital Care Research Forum Podcasts

Research & Best Practice

Each issue provides summaries of a selection of recent research from open access and Athensresources which are relevant to prehospital and emergency care.

I hope that you find the Prehospital Emergenc y Services Current Aw areness Upd ateuseful.

Feedback

The Emergency Services Current Aw areness Upd ateis produced bi-monthly by:

Alison Price, LibrarianLinco lnshire Knowledge and Resource Service

(on behalf of the National Ambulance Research Steering Group)

Email:[email protected]

This Current Awareness Update was commissioned by the National Ambulance Research Steering Groupcomprising of research leads from ambulance trusts in England, Scotland and Wales and other experts and groupssupporting prehospital research. The aim of the group is to support the strategic development of ambulance andprehospital research whether leading, collaborating in or using research.

The aim of this Current Awareness Update is to provide a digest of informationsupporting evidence based practice in prehospital emergency services, focusing uponresources from open access and NHS Evidence journals which are freely available to

Ambulance Trust staff, whether or not they have access to a dedicated library service.
mailto:[email protected]:[email protected]:[email protected]


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What's New?

10 priorities for resolving the crisis in emergency departmentsThis document urges stakeholders to work alongside the College to provide a stable long term future forA&E services whilst tackling short term pressures. These proposals are the collective view of practicingemergency physicians and aim to represent cost-effective solutions to ensure that safe patient care canbe delivered.

http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1

Ambulance survey 2013-1-2014: technical document Care Quality Commission (CQC)In this survey almost 3000 people gave their views of Hear and Treat services a 999 service, inwhich trained call handlers give medical advice over the telephone to avoid ambulances and paramedics

being sent out when they are not needed. The survey asked people, amongst other things, whether theyfelt reassured by staff, whether they were treated with dignity and respect, whether they understood theadvice given to them and whether they received an explanation if an ambulance was not sent out.

www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-still

Urgent and Emergency Care Review updateNHS England has published an update on the Urgent and Emergency Care Review. The publication

reports on work with local commissioners to development their strategic and operational plans andprovides an update on planning to develop demonstrator sites to trial new models, including the newNHS 111 service specification.

Extract:

Revised commissioning standards will ensure that:21. In our End of Phase 1 Report we identified that By extending paramedic training and skills, andsupporting them with GPs and specialists, we will develop our 999 ambulances into mobile urgenttreatment services capable of dealing with more people at scene, and avoiding unnecessary journeys tohospital. Accordingly, we have been working with Health Education England and other stakeholders onsupporting work they are leading which will reform the education and training of paramedics. We havealso, with the help of our Delivery Group, developed drafts of potential guidance which set out a new

specification for how ambulance services could and should be delivered in the future to achieveimportant elements of our vision. Again, we are continuing to develop this draft guidance and when thisprocess is complete we will release it to the service for use in development of local planning.

www.nhs.uk/NHSEngland/keogh-review/Documents/uecreviewupdate.FV.pdf
http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://www.nhs.uk/NHSEngland/keogh-review/Documents/uecreviewupdate.FV.pdfhttp://www.nhs.uk/NHSEngland/keogh-review/Documents/uecreviewupdate.FV.pdfhttp://www.nhs.uk/NHSEngland/keogh-review/Documents/uecreviewupdate.FV.pdfhttp://www.nhs.uk/NHSEngland/keogh-review/Documents/uecreviewupdate.FV.pdfhttp://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://www.cqc.org.uk/content/people-who-call-ambulance-are-positive-about-their-telephone-advice-improvements-stillhttp://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1http://secure.collemergencymed.ac.uk/Shop-Floor/Professional%20Standards/10%20priorities%20for%20Emergency%20Medicine/?dm_i=21A8,2GZO5,FLWOI3,916S0,1


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Discover the UCLA Prehospital Care Research Forum Podcasts

Prehospital Care Research Forum at the University of California, Los Angeles (UCLA)The UCLA Centre for Prehospital Care established the Prehospital Care Research Forum (PCRF) atUCLA in 1992. Its mission is to promote, educate and disseminate prehospital research conducted at allprovider levels to advance and challenge the future of emergency medical services.

Just one new podcast has been made available since the last Update for March and Aprilfollowthe link to listen and explore.

Improving Overtriage of Aeromedical Transport in TraumaA study published in Journal of Acute Care Surgery examined the implementation of a Trauma Advisory

Committee (TAC) to perform outreach and education of emergency medical agencies in the use ofAeromedical Transportation (AMT). This study discovered that after implementation of a processimprovement initiative (PI), there was a marked decrease (14%) in the percentage of AMT overtriage incounties with implementation of the PI when compared to counties without the PI.

www.fisdap.net/podcasts/pcrf/improving_overtriage_aeromedical_transport_trauma?t=pcrf

Prehospital Resource

Paramedic Network at Liverpool John Moores University

The Paramedic Network collates information, offers opinion and guidance, and promotes, develops and

supports high quality research and knowledge transfer by paramedics for paramedics. It does this by

connecting paramedics to an alliance of other specialists and this further facilitates research and

development that informs the profession and influences patient care in the future.'

www.cph.org.uk/expertise/injury/

The PCRF has produced a range of podcastswhich discuss

current research affecting emergency medical services. Thepodcasts aim to review methodology and applicability toprehospital care, promote healthy and respectful discussions,and inspire new research.

www.fisdap.net/podcasts/pcrf
http://www.fisdap.net/podcasts/pcrf/improving_overtriage_aeromedical_transport_trauma?t=pcrfhttp://www.fisdap.net/podcasts/pcrf/improving_overtriage_aeromedical_transport_trauma?t=pcrfhttp://www.fisdap.net/podcasts/pcrf/improving_overtriage_aeromedical_transport_trauma?t=pcrfhttp://www.cph.org.uk/expertise/injury/http://www.cph.org.uk/expertise/injury/http://www.cph.org.uk/expertise/injury/http://www.fisdap.net/podcasts/pcrfhttp://www.fisdap.net/podcasts/pcrfhttp://www.fisdap.net/podcasts/pcrfhttp://www.fisdap.net/podcasts/pcrfhttp://www.cph.org.uk/expertise/injury/http://www.fisdap.net/podcasts/pcrf/improving_overtriage_aeromedical_transport_trauma?t=pcrf


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Research & Best Practice

The following research papers have been published, or made available online, in the last coupleof months. This is not a comprehensive overview, but represents papers which are freelyavailable in full text, with current internet links provided.

Papers listed asOpen Access @ are freely available in full text from the link provided.

Papers with links listed asAthens Access @ require you to log in with a freeNHS Athens

username and password to obtain the full text. These links take you to the abstract initially. To readthe whole paper, choose either full text or pdf from the options on the abstract page. The full textoption will present the article as a single webpage, the puff . option will open as a digital copy of theoriginal paper. Selecting either will open a page with the following link for you to enter your Athensusername and password;

n.b.A number of papers are poster presentationsfrom conferencesfor these papers, only theabstract is available. A paper discussing the need for full-text poster publication also features in thisupdate.

The research papers have been arranged by the topic headings below:

Prehospital Services - Development and Quality

Prehospital PractitionersProfessional Development

Prehospital ResearchMethods and Discussion

Dispatch, Response and Handover

Patient Profile

Helicopter Emergency Medical Services

Diagnosis, Triage and Intervention

Drug Treatment

Airway Management, Resuscitation & CPR

To create your own Athens usernameand password, simply visit:https://register.athensams.net/nhs/

You can find the complete archiveof the Prehospital Emergency Services CurrentAwareness Update at the link below, with thanks to Matt Holland of the North WestAmbulance Library and Information Service:

www.networks.nhs.uk/nhs-networks/nwas-library-and-information-service/esca
https://register.athensams.net/nhs/http://www.networks.nhs.uk/nhs-networks/nwas-library-and-information-service/escahttp://www.networks.nhs.uk/nhs-networks/nwas-library-and-information-service/escahttp://www.networks.nhs.uk/nhs-networks/nwas-library-and-information-service/escahttps://register.athensams.net/nhs/


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Prehospital Services - Development and Quality

Adherence to Prehospital Traumatic Brain Injury GuidelinesThis Danish study investigated adherence to guidelines, reasons for non-adherence, and complicationsrelated to prehospital advanced airway management in traumatic brain injury patients with an initial

Glasgow Coma Scale score of


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Compliance with Guidelines for Prehospital Traumatic Brain Injury ManagementThis study used data from trauma registry and ambulance records to assess compliance with guidelinesfor prehospital management of severe traumatic brain injury in Stockholm, looking at assessment and/ortreatment of airway, ventilation, oxygenation, blood pressure, fluid resuscitation, GCS, and pupilproperties. Prehospital management considered compliant only if assessment or treatment wasdocumented in the ambulance journal. A 65% criterion was used as a lower limit for acceptablecompliance. The results showed practice to be compliant with guidelines to a large extent, and higherthan in previous studies.

Rubenson Wahlin R, Gustavsson J, Castrn M. Poster presentation- Prehospital management ofsevere traumatic brain injury- compliance with guidelines.Scandinavian Journal of Trauma,Resuscitation and Emergency Medicine, 2014, 22:P1Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P1.pdf

Computerised Decision Support Systems to Support Prehospital Patient AssessmentThere is limited evidence relating to the effect of Computerized Decision Support Systems on guidelinecompliance in a prehospital setting. This time-series study of medical records evaluated the effect of theintroduction of CDSS on compliance with the basic assessment process set out in a clinical guidelineand the effect of On Scene Time (OST). Analysis of baseline and post-intervention data should that

compliance rose significantly after the introduction of the CDSS and the post-intervention slope was

stable. No effect was demonstrated in relation to On Scene Time.

Andersson HM, Suserud B, Andersson-Gre B et al. The effect of a Computerised Decision SupportSystem (CDSS) on compliance with the prehospital assessment process: results of an interruptedtime-series study. BMC Medical Informatics and Decision Making, 2014, 14:70Open Access @www.biomedcentral.com/content/pdf/1472-6947-14-70.pdf

Integrated Resuscitation ServiceThis poster describes a prehospital service where the deployment of a specialist physician response unit

(PRU) has enabled the early delivery of critical care interventions (including therapeutic hypothermia(TH) and immediate percutaneous coronary intervention (PCI)) and the direct transfer of unstable out-of-

hospital cardiac arrest patients to a cardiac intervention centre. Data for 28 patients attended by the PRUover two months showed overall survival to cardiac intensive care to be 56%, with overall survival todischarge 48%. The authors note that the PRU service can optimise outcomes in selected cases.

Hunter-Dunn C. Poster presentation: An integrated resuscitation service, combining a pre - hospitalphysician response unit with delivery to a dedicated high-volume cardiac arrest centre, optimisessurvival following cardiac arrest.Scandinavian Journal of Trauma, Resuscitation and EmergencyMedicine, 2014, 22 : P17Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P17.pdf

Lessons from the Tokyo Subway AttackThe Japanese Sect Aum Shrinryko launched a terrorist attack on the Tokyo Underground in March 1995,

releasing the nerve agent sarin whose effects include coma, seizure and loss of centre respiratory drive.Over 5000 people needed medical assis tance, 980 of whom were moderately effected, 54 severelyinjured and 12 killed. Several papers were published in Japan reflecting on the emergency response,identifying lessons with a number of common themes including the need for physicians in command andcontrol centres, the ready availability of personal protective equipment, difficulties in diagnosis and

indetecting the agent which had been released. The authors of this extended essay discuss the lessonsnearly 20 years on with the benefit of hindsight, noting that many of the lessons learnt remain valid but

have in some cases been forgotten or overtaken by more recent events.

Byers M. Extended abstract: Deliberate chemical attack: revisiting the lessons of the Tokyo subwayattack. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2014, 22:A8Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-A8.pdf
http://www.sjtrem.com/content/pdf/1757-7241-22-S1-P1.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P1.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P1.pdfhttp://www.biomedcentral.com/content/pdf/1472-6947-14-70.pdfhttp://www.biomedcentral.com/content/pdf/1472-6947-14-70.pdfhttp://www.biomedcentral.com/content/pdf/1472-6947-14-70.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P17.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P17.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P17.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A8.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A8.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A8.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A8.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P17.pdfhttp://www.biomedcentral.com/content/pdf/1472-6947-14-70.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P1.pdf


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Mobile Videoconferencing for Emergency Medical CommunicationThis simulation study investigated the role of mobile phone videoconferencing lay bystanders andEmergency Medical Dispatch operators for initial emergency calls under suboptimal sound and lightconditions. Three different environments were used for the trials: indoors with moderate backgroundnoise, outdoors with daylight and much background noise, and outdoors during nighttime with littlebackground noise. Video and sound quality were evaluated with video quality found to be significantlydifferent between the groups, with nighttime the lowest although it was still possible to see actionsperformed on site during simulation. The authors conclude that videoconferencing on mobile phonescan be used for the initial emergency call during medical emergencies also in suboptimal conditions.

Melbye S, Hotvedt M, Bolle SR. Mobile videoconferencing for enhanced emergency medicalcommunication - a shot in the dark or a walk in the park? -- A simulation study. ScandinavianJournal of Trauma, Resuscitation and Emergency Medicine 2014, 22 :35Open Access @www.sjtrem.com/content/pdf/1757-7241-22-35.pdf

Prehospital Activation of Emergency TransfusionMajor Trauma Centres in England (MTCs) have adopted protocols to enable rapid access to bloodproducts for emergency transfusion in trauma when ongoing significant bleeding is identified. In someregions, prehospital services can request protocols and begin transfusion in the field. The authors of thispaper examined the emergency transfusion protocols and associated pack contents for MTCs in

England - 26/28 MTCs responded to their survey, all of whom reported having a written protocol.The authors report that twelve centres allowed prehospital physicians to remotely activate the protocol,but wide variation in both activation and provision of emergency transfusion exists. The authors note that

provision of prehospital blood may require MTCs to adapt the ratio of supplied products.

Evens T, Siu J, Russell M et al. Poster presentation: Prehospital activation of emergencytransfusion in trauma.Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2014 , 22 : P9Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P9.pdf

Prehospital Management of AsthmaBarriers and Facilitators

This research used focus groups to explore paramedics attitudes, perceptions and beliefs aboutprehospital management of Asthma with the aim of identifying barriers and facilitators to guidelineadherence. The seventeen participants included paramedics, advanced paramedics and paramedicoperational managers at three geographical sites. Five themes emerged from the analysis:(1) guidelines should be made more relevant to ambulance service care;(2) there were barriers to assessment;(3) the approach needed to address conflicts between clinicians and patients expectations;(4) the complexity of ambulance service processes and equipment needed to be taken into account;(5) there are opportunities for improved prehospital education, information, communication, support andcare pathways for asthma.

Shaw D, Siriwardena AN. Identifying barriers and facilitators to ambulance service assessment and

treatment of acute asthma: a focus group study. BMC Emergency Medicine, 2014, 14:18Open Access @www.biomedcentral.com/content/pdf/1471-227X-14-18.pdf
http://www.sjtrem.com/content/pdf/1757-7241-22-35.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-35.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-35.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P9.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P9.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P9.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-18.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-18.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-18.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-18.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P9.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-35.pdf


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Prehospital Mortality in Myocardial Infarction with ST-ElevationWhilst hospital mortality in myocardial infarction with ST-elevation has decreased recently, prehospitalmortality has not. This Spanish observational study used data from a register of patients attended inAndalusia over three years to idenfity initial complications and factors relating to prehospital mortality.Just over 2,500 patients were included, 24% were women. Fifty-two (2.1%) of patients died beforereaching hospital. An analysis of the data showed a significant proportion of these patients presentedearly complications in the prehospital setting, with prehospital mortality associated with being female andhaving an atypical presentation (including pre-existing conditions, hypotension and extensive infarction).

Rosell-Ortiz F, Mellado-Vergel FJ, Fernndez-Valle P et al. Initial complications and factors relatedto prehospital mortality in acute myocardial infarction with ST segment elevation. EmergencyMedicine Journal Published 25 July 2014, doi:10.1136/emermed-2014-203780Athens Access @http://emj.bmj.com/content/early/2014/07/25/emermed-2014-203780.abstract?papetoc

Rapid Extrication of Entrapped RTA VictimsPrehospital road vehicle entrapment is a risk factor for complications and delays transport to hospital.The Rapid Extrication (RE) method, which combines winching and cutting and utilises two larger vehiclesto pull car wreckage apart to extricate patients, has been studied previously and found to be an efficientalternative method. This Norwegian study surveyed all fire departments on their training in and

implementation of RE. Participants at the National Championship in RE, where extraction times were

measured, were also surveyed on training, cooperation and safety issues. The combined resultsshowed that interdisciplinary and regular training of RE can lead to safe extrication of a critically injuredpatient in less than 20 minutes and may be life saving.

Fattah S, Johnsen A, Andersen J et al.Rapid extrication of entrapped victims in motor vehiclewreckage using a Norwegian chain method - cross-sectional and feasibility study.BMC EmergencyMedicine 2014, 14 :14Open Access @www.biomedcentral.com/content/pdf/1471-227X-14-14.pdf

Review of Telemedicine in Prehospital CareThis literature review is part of the LiveCity project, examining the history and existing applications of

telemedicine in the prehospital environment. The studies included suggested that overall, te lemedicinehad a positive impact on emergency medical care, improving prehospital diagnosis of stroke andmyocardial infarction, enhancing supervision of delivery of tissue thromboplasminogen activator in acuteischaemic stroke. The authors note that while telemedicine presents an opportunity to enhance patientmanagement few studies have yet demonstrated whether it has an effect on clinical outcome.

Amadi-Obi A, Gilligan P, Owens N et al. Telemedicine in prehospital care: a review of telemedicineapplications in the prehospital environment.International Journal of Emergency Medicine, 2014,7:29Open Access @www.intjem.com/content/pdf/s12245-014-0029-0.pdf

Secondary Triage in Prehospital Emegency Ambulance ServicesThis systematic review examined the literature relating to the structure, safety and success of s econdarytelephone triage, where low-acuity patients are diverted to to a lternative non-ambulance services before

ambulance arrival. This system has been trialled in the UK and USA to manage increased demand.A low incidence of adverse effects was found and patients appeared to be satisfied with the system.However the authors note that, while secondary triage appears safe, further research is needed intoservice structure and the effect on ambulance demand.

Eastwood K, Morgans A, Smith K et al. Secondary triage in prehospital emergency ambulanceservices: a systematic review.Emergency Medicine Journal Published 1 May 2014Athens Access @http://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetoc
http://emj.bmj.com/content/early/2014/07/25/emermed-2014-203780.abstract?papetochttp://emj.bmj.com/content/early/2014/07/25/emermed-2014-203780.abstract?papetochttp://emj.bmj.com/content/early/2014/07/25/emermed-2014-203780.abstract?papetochttp://www.biomedcentral.com/content/pdf/1471-227X-14-14.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-14.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-14.pdfhttp://www.intjem.com/content/pdf/s12245-014-0029-0.pdfhttp://www.intjem.com/content/pdf/s12245-014-0029-0.pdfhttp://www.intjem.com/content/pdf/s12245-014-0029-0.pdfhttp://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetochttp://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetochttp://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetochttp://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetochttp://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetochttp://emj.bmj.com/content/early/2014/04/30/emermed-2013-203120.abstract.html?papetochttp://www.intjem.com/content/pdf/s12245-014-0029-0.pdfhttp://www.biomedcentral.com/content/pdf/1471-227X-14-14.pdfhttp://emj.bmj.com/content/early/2014/07/25/emermed-2014-203780.abstract?papetoc


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Stroke Awareness Campaign in IrelandLittle evidence is available regarding the effectiveness of media messages to influence behaviour afterstroke onset. This study assessed the impact of the introduction of the F.A.S.T. (Face Arm Speech Time)stroke recognition tool in two Irish emergency departments. The campaign was found to have had aninitial impact on emergency department attendance of patients with stroke symptoms but that this effectwas not sustained. Prehospital delay in accessing acute stroke services was found to be a factor, but theauthors report this is a complex process with involvement of factors other than stroke knowledge andintention to call 911.

Mellon L, Hickey A, Doyle F et al. Can a media campaign change health service use in a populationwith stroke symptoms? Examination of the first Irish stroke awareness campaign.EmergencyMedicine Journal 2014;31:536-540 doi:10.1136/emermed-2012-202280Athens Access @http://emj.bmj.com/content/31/7/536.abstract.html?etoc

Unmanned Aerial Vehicle Suppport for Situation Assessment in a Mass Casualty IncidentThis study evaluated the feasibility of using a remotely piloted unmanned aerial vehicle (UAV) to gatherinformation from the air in order to support decision-making in a simulated major mass-casualty incident(25 children trapped on a school bus after collision). The study provided useful information on how tocollect, interpret and make use of the data to improve the processes of assessing the scene, makesound decisions and distribute resources according to need. The authors note these devices might be

particularly useful in high-risk environments with limited access to patients.

Abrahamsen H. Poster presentation: How to improve situation assessment and decision-making ina simulated mass casualty incident by using an unmanned aerial vehicle. Scandinavian Journal ofTrauma, Resuscitation and Emergency Medicine. 2014, 22:P2Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P2.pdf

Unmanned Aerial Vehical Support for Situation Assessment in Mountain RescueThis Norwegian study assessed the feasibility of using a radio-controlled rotor-wing unmanned aerialvehicle to support situation assessment in search and rescue operations in the mountains. Twosimulated scenarios were set up: an avalanche and an injured skier trapped in a narrow canyon with

unstable snow overhead. Live video, turn directions and digital signals were wirelessly transmitted to aground station and allowed ski tracks leading to the canyon, and objects in the snow to be identifiedremotely. The authors comment that the Unmanned Aerial Vehicle is an effective tool carrier and savestime by spanning large geographical area in rough terrain. Equipping the vehicle with an avalanchetransceiver and a HD camera provided useful decision-making support for emergency services.

Abrahamsen H. Poster presentation: Use of an unmanned aerial vehicle to support situationassessment and decision-making in search and rescue operations in the mountains. ScandinavianJournal of Trauma, Resuscitation and Emergency Medicine 2014, 22 :P16Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P16.pdf

Wireless Electroencephalography in Prehospital CareThis paper describes the design and testing of a novel six-channel emergency electroencephalography(EEG) recording system for use in emergency medicine and prehospital care. Bench testingdemonstrated the system's performance to be comparable with a commercial system. The authorssuggest the system could be used to record high-quality EEG data during ambulance transportation,

leading to faster diagnostic, more accurate treatment, and shorter recovery times for patients withneurological brain disorders.

Jakab A, Kulkas A, Salpavaara T et al. Novel wireless electroencephalography system with aminimal preparation time for use in emergencies and prehospital care. BioMedical EngineeringOnLine, 2014, 13 :60Open Access @www.biomedical-engineering-online.com/content/pdf/1475-925X-13-60.pdf
http://emj.bmj.com/content/31/7/536.abstract.html?etochttp://emj.bmj.com/content/31/7/536.abstract.html?etochttp://emj.bmj.com/content/31/7/536.abstract.html?etochttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P2.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P2.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P2.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P16.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P16.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P16.pdfhttp://www.biomedical-engineering-online.com/content/pdf/1475-925X-13-60.pdfhttp://www.biomedical-engineering-online.com/content/pdf/1475-925X-13-60.pdfhttp://www.biomedical-engineering-online.com/content/pdf/1475-925X-13-60.pdfhttp://www.biomedical-engineering-online.com/content/pdf/1475-925X-13-60.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P16.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P2.pdfhttp://emj.bmj.com/content/31/7/536.abstract.html?etoc


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Prehospital PractitionersRoles, Professional Practice and Development

Impact of Extended Paramedic Skills on the Emergency Care SystemAgainst the background of rising demand for UK emergency services and the fact that just 10% ofemergency calls are life-threatening, this paper systematically reviews the literature on the potential forparamedics with extended skills to reduce demand on emergency departments. Fourteen relevantarticles were identified, revealing valuable evidence relating to the autonomous assessment andmanagement of patients by paramedics reducing onward transport to hospital. The authors note thatother evidence was less strong but that they recommend future research particularly regarding

paramedic care of older people.

Evans R, McGovern R, Birch J et al. Which extended paramedic skills are making an impact inemergency care and can be related to the UK paramedic system? A systematic review of theliterature. Emergency Medicine Journal 2014; 31:594-603 PAthens Access @http://emj.bmj.com/content/31/7/594.full.pdf+html

Paramedic IntubationA controversial topic in emergency medicine is the inclusion of endotracheal intubation within the scopeof practice for non-physician providers in the prehospital environment.With no clear evidence for or against there is considerable variability in practice throughout the world.

To better understand this topic separate this paper addresses four separate but related issues:1) the physiological rationale for early intubation during resuscitation2) the inconsistency of published reports addressing this controversy

3) the possibility that suboptimal performance of ETI and subsequent ventilation can explain a lack ofoutcomes benefit4) the relationship between provider type, training, and airway skills performance.

Davis D. Extended abstract - Paramedic intubation.Scandinavian Journal of Trauma, Resuscitationand Emergency Medicine, 2014, 22:A2Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-A2.pdf

Patient Experiences of Emergency Care PractitionersThis study used a postal questionnaire to compare patient experiences of care provided by emergencycare practitioners and usual providers in different emergency and urgent care settings. The resultsshowed users of ECP services were more likely to be highly satisfied with overall care than usualprovider patients in the various study settings.

O'Keeffe C, Mason S, Knowles E. Patient experiences of an extended role in healthcare: comparingemergency care practitioners (ECPs) with usual providers in different emergency and urgent caresettings. Emergency Medicine JournalAthens Access @http://emj.bmj.com/content/31/8/673.abstract.html?etoc

Prehospital Administration of Fascia Iliaca Compartmental Block by NursesIn the Netherlands, prehospital emergency care is mostly provided by emergency medical servicenurses. This study examined whether, after training, EMS-nurses could successfully perform a fasciailiaca compartment block on-scene (usually performed by physicians) as an alternative to intravenous

analgesics in patients with proximal femur fracture. Ten EMS-nurses received training, and wereincluded on ambulance teams dispatched to patients with suspected proximal femur fracture. Onehundred patients received the block which was effective in 96 with very high patient satisfaction and noreported complication.

Dochez E, van Geffen GJ, Bruhn J et al. Prehospital administered fascia iliaca compartment blockby emergency medical service nurses, a feasibility study. Scandinavian Journal of Trauma,Resuscitation and Emergency Medicine 2014, 22 :38 (23 June 2014)Open Access @www.sjtrem.com/content/pdf/1757-7241-22-38.pdf
http://emj.bmj.com/content/31/7/594.full.pdf+htmlhttp://emj.bmj.com/content/31/7/594.full.pdf+htmlhttp://emj.bmj.com/content/31/7/594.full.pdf+htmlhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A2.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A2.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A2.pdfhttp://emj.bmj.com/content/31/8/673.abstract.html?etochttp://emj.bmj.com/content/31/8/673.abstract.html?etochttp://emj.bmj.com/content/31/8/673.abstract.html?etochttp://www.sjtrem.com/content/pdf/1757-7241-22-38.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-38.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-38.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-38.pdfhttp://emj.bmj.com/content/31/8/673.abstract.html?etochttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A2.pdfhttp://emj.bmj.com/content/31/7/594.full.pdf+html


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Retired Military Service Volunteers - Readiness to Deploy in DisastersThe Department of Veterans Affairs Disaster Emergency Medical Personnel System (DEMPS)programme in America provides a system whereby active or retired veteran military personnel canregister to be deployed during national emergencies or disasters, with training provided. This study useda survey to identify factors impacting upon a willingness to deploy in the event of an emergency.Findings from the 2,385 survey respondents (a 29% response rate) revealed volunteer experience, apositive attitude to training were associated with readiness to deploy. Stress and female gender wereassociated with being less likely to show a readiness to deploy. The authors discuss how to addressfactors which impact upon a willingness to deploy.

Zagelbaum NK, Heslin KC, Stein JA et al. Factors influencing readiness to deploy in disasterresponse: findings from a cross-sectional survey of the Department of Veterans Affairs DisasterEmergency Medical Personnel System.BMC Emergency Medicine 2014, 14 :16Open Access @www.biomedcentral.com/content/pdf/1471-227X-14-16.pdf

Role of General Practitioners in Prehospital CareThis Norwegian study used focus groups to gain better insight into emergency medical technicians'experiences with the role of the GPs in the care for critically ill patients in the prehospital setting.The EMTs reported feeling the need for GP participation in the ambulance when responding to acritically ill patient, particularly in difficult cases which did not fit into EMT guidelines. The

main contributions of the GPs were described as diagnosis and decision-making, including shorteningtransport to hospital time and starting medication earlier. The authors report GP presence to beperceived as improving patient care. The EMTs did suggest formalised training between themselves and

GPs on call.

Hjortdahl M, Zakariassen E, Wisborg T. The role of general practitioners in the prehospital setting,as experienced by emergency medicine technicians: a qualitative study. Scandinavian Journal ofTrauma, Resuscitation and Emergency Medicine, 2014, 22:47Open Access @www.sjtrem.com/content/pdf/s13049-014-0047-1.pdf

Using Cadavers to Improve Safety in Placing Unconscious Trauma Patients

This study used cadavers to explore the level of motion produced by lateral position techniques(Recovery Position, Lateral Trauma Position, HAINES position and variations) in unconscious patientswith possible unstable cervical spine injuries. Global ligamentous instability between C5 and C6 wascreated in five fresh cadavers. Relative motion was measured using an electromagnetic tracking device.The results indicated that the LTP or one of the two HAINES techniques was preferable to the classicrecovery position in the setting of an unstable cervical spine injury.

Hyldmo P, Conrad B, Dubose D et al. Oral presentation : Learning from the dead: improving safetywhile placing unconscious trauma patients in various lateral positions. Scandinavian Journal ofTrauma, Resuscitation and Emergency Medicine, 2014, 22:O4Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-O4.pdf

Using Frozen Cadavers to Enhance Simulation TrainingConcerned that a reliance on simulation learning using mannequin-based models may sufficientlyprepare paramedic students for variance in human anatomy, the Queensland University of Technologypiloted a three-hour fresh frozen human cadaveric training workshop for second-year undergraduateparamedic students in 2012. One hundred and fourteen students attended the workshop and an analysisof evaluations showed a statistically significant improved anatomical knowledge and confidence inprocedural skills including laryngeal mask insertion, airway management, bag-valve-mask,thoracocentesis and traction splinting. The authors suggest that cadaveric training using fresh frozencadavers provides an effective adjunct to simulated learning and clinical placements.

Lim et al. Enhancing paramedics procedural skills using a cadaveric model. BMC MedicalEducation 2014, 14:138

Open Access @www.biomedcentral.com/content/pdf/1472-6920-14-138.pdf
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Prehospital ResearchMethods and Discussion

Design of Emergency Research Where Consent Must Be WaivedThis commentary paper discusses issues of ethics in emergency care research, where it can beimpossible or inappropriate to obtain the necessary consent and consultation for participating in researchstudies at the time of the emergency. This has consequences for the development of an evidence base.The authors describe a practical framework, developed at a workshop hosted by the UK Health

Research Authority, providing questions andconsiderations which aim to givea structured approach tothe issues arising when developing or reviewing research that involves a waiver of consent orconsultation.

Davies H, Shakur H, Padkin M et al. Guide to the design and review of emergency research when itis proposed that consent and consultation be waived. Emergency Medicine Journal 31:794-795Athens Access @http://emj.bmj.com/content/31/10/794.extract?etoc

Issues of ethics and consent were discussed in the media in Au gust 2014, when a control led tr ialby

Warwic k University wh ich wou ld see some cardiac arrest patients given a placebo in place of adrenaline

was granted approval to begin in the Autum n. The study is descr ibed as fol lows:

The University of Warwick Clinical Trials Unit is carrying out this study with five ambulance services across the UK.We will collect information about 8,000 patients who have been treated for cardiac arrest. Half of the patients willhave been treated with adrenaline and half will have been treated with placebo (dummy). The study will look atsurvival at 30 days after cardiac arrest in both groups and explore the effects of adrenaline on brain function. If thepatient wants to take part in the follow up this will involve completing questionnaires about their quality of life andgeneral health at 3 and 6 months after the cardiac arrest.

www.controlled-trials.com/isrctn/pf/73485024

The BBC reported the story with discussion of the Ethics of life -and-death research.

www.bbc.co.uk/news/health-28770885

Full Text Publication of Emergency Conference AbstractsThis survey investigated the publication rate of papers presented at the Danish Emergency MedicineConferences in 2009, 2010 and 2011. The authors note that abstracts presented at conferences andscientific meetings should ideally be published as articles in peer-reviewed journals regardless of theirfindings but found the publication rates for the 2009 and 2010 to be around 30%, with only 14.5% ofpapers from the 2011 conference having been published within 18 months. The authors report that theDanish rates compare with other emergency research communities, but all are lower than for moreestablished specialties. The authors discuss reasons fro non-publication.

Ravn A, Petersen D, Folkestad L et al. Full-text publication of abstracts in emergency medicine inDenmark.Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22 :33

Open Access @www.sjtrem.com/content/pdf/1757-7241-22-33.pdf

Future of Traumatic Brain Injury ResearchThis extended essay presents the evolution of research in Traumatic Brain Injury (TBI) with two changesin direction in the quest for higher level evidencefirstly a move from randomised prospectiveinterventional trials to an era of big data observational studies and secondly the transfer of monitoringtechnologies into the prehospital field. The authors discuss the way that these changes should enable a

better understanding of the spectrum of TBI diseases and foster a future of more precise, personalisedmanagement.

Wilson M, Zolfaghari P, Griffin C et al. Extended abstract - The future of traumatic brain injury

research.Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:A7Open Access @www.sjtrem.com/content/22/Suppl%201/A7
http://emj.bmj.com/content/31/10/794.extract?etochttp://emj.bmj.com/content/31/10/794.extract?etochttp://emj.bmj.com/content/31/10/794.extract?etochttp://www.controlled-trials.com/isrctn/pf/73485024http://www.controlled-trials.com/isrctn/pf/73485024http://www.controlled-trials.com/isrctn/pf/73485024http://www.bbc.co.uk/news/health-28770885http://www.bbc.co.uk/news/health-28770885http://www.bbc.co.uk/news/health-28770885http://www.sjtrem.com/content/pdf/1757-7241-22-33.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-33.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-33.pdfhttp://www.sjtrem.com/content/22/Suppl%201/A7http://www.sjtrem.com/content/22/Suppl%201/A7http://www.sjtrem.com/content/22/Suppl%201/A7http://www.sjtrem.com/content/22/Suppl%201/A7http://www.sjtrem.com/content/pdf/1757-7241-22-33.pdfhttp://www.bbc.co.uk/news/health-28770885http://www.controlled-trials.com/isrctn/pf/73485024http://emj.bmj.com/content/31/10/794.extract?etoc


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Horizon Scanning in Traumatic Brain InjuryWith up to 62% of severe injuries in British patients including traumatic brain injury, this project aimed toevaluate current best-practice for gaps in knowledge, care, and research, to determine what changescould best improve TBI care, and to project optimum treatment for 2020.

Roberts N, ODochartaigh D, Aleksandrowicz D et al. Poster presentation: Traumatic Brain Injury in2020a horizon-scanning project. Scandinavian Journal of Trauma, Resuscitation and EmergencyMedicine 2014, 22:P6Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P6.pdf

London Trauma and Cardiac Arrest Conference 2013The seventh London Trauma Conference was held over four days in December 2013. This supplementprovides a selection of seven extended abstracts written by speakers at the conference illustrating someof the diverse subject matter covered and also the scientific abstracts from oral and poster presentationsmade at the conference.

Bird F, Avery P. London Trauma and Cardiac Arrest Conference 2013.Scandinavian Journal ofTrauma, Resuscitation and Emergency Medicine. 2014, 22:A1Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-A1.pdf

Prehospital Clinical TrialsFeasibility and PracticalitiesThis study based in ambulance stations in Yorkshire used a questionnaire to explore paramedicsperceptions of prehospital research and barriers to conducting prehospital c linical trials. An interest in,and understanding of, research was reported but limited support for paramedic involvement in trials wasrevealed, with barriers included the practicality and ethics of randomisation and consent, and timepressures.

Hargreaves K, Goodacre S, Mortimer P. Paramedic perceptions of the feasibility and practicalitiesof prehospital clinical trials: a questionnaire survey.Emergency Medicine Journal 2014; 31:499-504Athens Access @http://emj.bmj.com/content/31/6/499.abstract.html?etoc

Time Series Studies in the Quality of Prehospital Myocardial Infarction CareThis paper examined the strength of interrupted time series design as a methodology to evaluate theeffect of interventions introduced at a specific point in time. The intervention examined with this methodwas a collaborative quality improvement intervention in prehospital ambulance care for acute myocardialinfarction and stroke. Segmented regression analysis, the recommended approach, was used to analysedata. Insufficient evidence of a statistically significant effect on quality of this intervention was found, butpotentially clinically important effects for acute myocardial infarction could not be ruled out.

Taljaard M, McKenzie J, Ramsay C et al. The use of segmented regression in analysing interruptedtime series studies: an example in prehospital ambulance care. Implementation Science, 2014, 9:77Open Access @www.implementationscience.com/content/pdf/1748-5908-9-77.pdf

Dispatch, Response and Handover

Clinical Handovers Between Prehospital and Hospital StaffThis paper reviewed the published research on the interface between prehospital and hospital settings inclinical handovers. Twenty-one studies met the literature search inclusion criteria and themes aroundcommunication and information transfer within varying environmental and professional relationshipcontexts were raised. The quality of existing research was found to be relatively poor and the authors ofthis review note the need for more research to understand this complex issue before enable tools and

techniques for standardisation can be developed.

Wood K, Crouch R, Rowland E et al. Clinical handovers between prehospital and hospital staff:literature review. Emergency Medicine Journal Published 1 September 2014Athens Access @http://emj.bmj.com/content/early/2014/09/01/emermed-2013-203165.abstract?papetoc
http://www.sjtrem.com/content/pdf/1757-7241-22-S1-P6.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P6.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P6.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A1.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A1.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A1.pdfhttp://emj.bmj.com/content/31/6/499.abstract.html?etochttp://emj.bmj.com/content/31/6/499.abstract.html?etochttp://emj.bmj.com/content/31/6/499.abstract.html?etochttp://www.implementationscience.com/content/pdf/1748-5908-9-77.pdfhttp://www.implementationscience.com/content/pdf/1748-5908-9-77.pdfhttp://www.implementationscience.com/content/pdf/1748-5908-9-77.pdfhttp://emj.bmj.com/content/early/2014/09/01/emermed-2013-203165.abstract?papetochttp://emj.bmj.com/content/early/2014/09/01/emermed-2013-203165.abstract?papetochttp://emj.bmj.com/content/early/2014/09/01/emermed-2013-203165.abstract?papetochttp://emj.bmj.com/content/early/2014/09/01/emermed-2013-203165.abstract?papetochttp://www.implementationscience.com/content/pdf/1748-5908-9-77.pdfhttp://emj.bmj.com/content/31/6/499.abstract.html?etochttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-A1.pdfhttp://www.sjtrem.com/content/pdf/1757-7241-22-S1-P6.pdf


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Comparing Actual Versus Predicted Emergency Ambulance Journey TimesThis study retrospective cohort study of emergency ambulance admissions in the northeast of Englandexamined how accurately commercially available GIS packages could predict emergency ambulancejourney times under differing conditions. The study results showed statistically significant under-prediction of journey times for all population densities, but the authors suggest this is not likely to besignificant clinically and that i t would be reasonable to use generic GIS software with small adjustmentsto account for under-prediction.

McMeekin P, Gray J, Ford GA et al. A comparison of actual versus predicted emergency ambulance

journey times using generic Geographic Information System software. Emergency MedicineJournal Emergency Medicine Journal 2014; 31:758-762Athens Access @http://emj.bmj.com/content/31/9/758.abstract?etoc

Clinical Deterioration During Long Ambulance JourneysThis research used a retrospective chart review of 991 patients to investigate whether clinical

deterioration occured in patients during long ambulance journeys (up to 70 miles) to hospital in a ruralarea of Wales. The NHS Early Warning Score was used to estimate illness severity on ambulance arrivalat scene and at the emergency department, and relationship with distance from hospital analysed.No statistically significant relationship was found, for the patients as a single group or when sub-categorised into clinical groups. The authors suggest that adult patients living further from hospital are

not more unwell on pick-up, they are not deteriorating en-route, and longer journeys to hospital do notnecessarily lead to patients coming to harm. The authors note they did not explore any relationship tolater mortality/morbidity and call for this research to be replicated in other areas to provide more

evidence.

Thorp V, Kang S, Dykes L. The Long And Winding Road: Do Patients Deteriorate During LongAmbulance Journeys To Hospital. Emergency Medicine Journal 2014; 31:785Athens Access @http://emj.bmj.com/content/31/9/785.1.abstract?etoc

Patient Profile

Care Home Resident Use of Emergency AmbulancesThis paper reports on a longitudinal study that tracked 133 older people with dementia, resident in carehomes in the East of England with no on-site nursing providing personal care only, to examine thefrequency and reasons for emergency ambulance call-outs, outcomes and factors associated withemergency ambulance service use. The tracking showed that 56% of residents used ambulanceservices with 43% of all call-outs resulting in an unscheduled admission to hospital. In addition to traumafollowing a following a fall a reasonable proportion of ambulance contacts were shown to be forambulatory care sensitive conditions. The authors call for further examination of this vulnerablepopulation, to take account of important contextual factors including the presence or absence of on-sitenursing, GP involvement, and access to residents family, alongside resident health characteristics.

Amador S, Goodman C, King D et al. Emergency ambulance service involvement with residential

care homes in the support of older people with dementia: an observational study. BMC Geriatrics,2014, 14:95Open Access @www.biomedcentral.com/content/pdf/1471-2318-14-95.pdf
http://emj.bmj.com/content/31/9/758.abstract?etochttp://emj.bmj.com/content/31/9/758.abstract?etochttp://emj.bmj.com/content/31/9/758.abstract?etochttp://emj.bmj.com/content/31/9/785.1.abstract?etochttp://emj.bmj.com/content/31/9/785.1.abstract?etochttp://emj.bmj.com/content/31/9/785.1.abstract?etochttp://www.biomedcentral.com/content/pdf/1471-2318-14-95.pdfhttp://www.biomedcentral.com/content/pdf/1471-2318-14-95.pdfhttp://www.biomedcentral.com/content/pdf/1471-2318-14-95.pdfhttp://www.biomedcentral.com/content/pdf/1471-2318-14-95.pdfhttp://emj.bmj.com/content/31/9/785.1.abstract?etochttp://emj.bmj.com/content/31/9/758.abstract?etoc


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Does Patient Gender Affect Prehospital Care?Research in fields of emergency medicine including cardiovascular and intensive care has shown thatwomen receive inferior care. This observational retrospective study of 305 patients investigated whetherthere were gender differences in the prehospital care given to severely injured adult trauma patients inStockholm. Variables including age, injury mechanism and 30-day mortality were comparable betweengenders and no statistically significant gender differences were found in airway management,administration of oxygen, fluids, analgesics, and stabilization of neck and spine. On-scene time nor totalprehospital time did not significantly differ between.

Rubenson Wahlin R, Lvbrand H, Castrn M et al. Oral presentation : Evaluating prehospital traumacare in Stockholm from a gender perspective.Scandinavian Journal of Trauma, Resuscitation andEmergency Medicine, 2014, 22:O2Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-O2.pdf

Emergency Service Frequent Callers and UsersThe authors of this systematic review searched for primary research examining the characteristics andimpact of frequent users upon emergency medical services of research on frequent users of EMS.Eighteen relevant studies were retrieved. No two studies used the same definition for frequent users,and the percentage of patients identified as frequent callers reported ranged from 0.2% to 23%. None ofthe studies focused upon the callers characteristics. The authors call for research to identify predictors

and characteristics of frequent users and a consistent definition of a frequent caller to or user ofemergency medical services.

Scott J, Strickland AP, Warner K et al. Frequent callers to and users of emergency medicalsystems: a systematic review. Emergency Medicine Journal 2014; 31:684-691Athens Access @http://emj.bmj.com/content/31/8/684.abstract.html?etoc

Exercise Related Sudden Cardiac DeathIncidence and Bystander ResponseThis retrospective observation study used data from the London Ambulance Service Cardiac ArrestRegistry to assess the incidence of, and survival from, exercise-related sudden cardiac arrest in London.Incidence was found to be rare, estimated at 6.1 per million per population per year, with the majority of

cases male. Incidence increased from age 40. The most common activities engaged in at the time ofSCA were running/jogging, football and cycling. Just under one third of patients survived to hospitaldischarge. Three-quarters of arrests were witnessed by a bystander. Bystander CPR was initiated in62% of cases. Public defibrillators were available in 7% of arrests but only used in 4% of arrests.

Edwards M, Fothergill R, Whitbread M. Oral presentation: Exercise-related sudden cardiac arrest inLondon: incidence, survival, and bystander response.Scandinavian Journal of Trauma,Resuscitation and Emergency Medicine 2014, 22:O3Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-O3.pdf

Patients who Call Ambulances for Primary Care ProblemsThis research used semi-structure interviews to aim to understand the decision making process by bothpatients and carers when an ambulance has been called for problems which could be dealt withappropriately in primary care. Analysis showed many calls were based on a fundamental misconceptionof types of urgent care other than calling an ambulance, such as community-based urgent care services.

Chronically ill patients with frequent exacerbations were identified as a group for whom education mightbe suitable. Decisions made by carers were found to be driven by lower tolerance of perceived risk. Theauthors note that perceived distances between urgent primary care and ambulance responses mightinfluence decision making and discuss the potential for a greater role in detailed triage.

Booker MJ, Simmonds RL, Purdy S. Patients who call emergency ambulances for primary careproblems: a qualitative study of the decision-making process.Emergency Medicine JournalAthens Access @http://emj.bmj.com/content/31/6/448.abstract.html?etoc
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Penetrating TraumaIncidence Over Time in LondonUsing a retrospective review of the London Air Ambulance database to identify patients sustainingdeliberate penetrating trauma from 2007 to 2012 the authors of this study aimed to assess whether atrend towards an annual rise in these injuries reported between 1991 and 2006 had continued.The median number of penetrating trauma cases attended per year was 95 between 1991 and 2006,and 352.5 from 2007 to 2012 representing 9.9% and 19.3% of the annual trauma caseload respectively.The authors discuss the rise and the impact on the provision of trauma services and policing.

Crewdson K, Weaver A, Davies G et al. Poster presentation: The incidence of penetrating trauma in

London: have previously reported increases persisted in the last six years?Scandinavian Journalof Trauma, Resuscitation and Emergency Medicine, 2014, 22:P3Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P3.pdf

Helicopter Emergency Medical Services

Analysis of Regional Intensive Care Transport SystemsSecondary intensive care patient transport missions can be managed by road ambulance, rotor-wingambulance, and fixed-wing ambulance. This Swedish paper used prospectively collected data to test thehypothesis that costs for transport distances would differ between the three systems. Economicmodelling allowed the authors to compare results taking into account cost and time effectiveness,

revealing that helicopters can be effective up to moderate transport distances (400500km), but wereexpensive to operate. For longer ICU patient transports, fixed-wing transport systems were found to beboth cost and time effective compared to helicopter-based systems.

Brndstrm H, Wins O, Lindholm L et al. Regional intensive care transports: a prospectiveanalysis of distance, time and cost for road, helicopter and fixed-wing ambulances. ScandinavianJournal of Trauma, Resuscitation and Emergency Medicine 2014, 22 :36Open Access @www.sjtrem.com/content/pdf/1757-7241-22-36.pdf

Clotted Haemopericardium in Traumatic Cardiac ArrestCurrent guidelines emphasise the use of emergency thoracotomy rather than needle pericardiocentesis

to treat cardiac tamponade. Londons Air Ambulanceservice has performed the procedure for traumaticcardiac arrest since 1993. This five year retrospective study of data aimed to validate the swing frompericardiocentris to thoracotomy. Data for 152 patients revealed a significant percentage of tamponades(47%) to be clotted haemopericardium, making the shift in trauma management appropriate.

Manz E, Nofz L, Norman A et al. Poster presentation: Incidence of clotted haemopericardium intraumatic cardiac arrest in 152 thoracotomy patients.Scandinavian Journal of Trauma,Resuscitation and Emergency Medicine 2014, 22:P20Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P20.pdf

Intranasal Analgesia in UK Air Ambulance ServicesLondons Air Ambulance (LAA) is considering introducing an intranasal analgesia standard operating

procedure and this study used a telephone survey to determine the current use, or planned introduction,of INA in 19 other air ambulance providers in the UK. Data was obtained for 16 of the providersrevealing that 75% of these providers either currently use or plan to introduce INA in the near future. Theauthors note that this represents a large pool of clinical experience and expertise which can guide LAA intheir decision to introduce INA to their current analgesia SOPs.

Pascoe C, James S, Smith C et al. Poster presentation: What UK prehospital providers useintranasal analgesia? A survey of its current and planned use by air ambulance services in theUnited Kingdom. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014,22 : P15Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P15.pdf
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Obstetric Caseload of a Physician-Based Helicopter Emergency Medical ServiceRetrieval records over 4 years for the Greater Sydney Area Helicopter Emergency Medical Service weresearched to identify keywords associated with pregnancy or obstetric complications with the aim ofquantifying the obstetric caseload for the service and then to provide targeted training. Of the 66 casesfound, half were retrieved for non-obstetric diagnoses and obstetric interventions by HEMS physicianswere rare. The authors note that educational resources should prioritise general critical care of thepregnant woman rather than specific obstetric procedures.

Kaye R, Shewry E, Reid C et al. The obstetric caseload of a physician-based helicopter emergency

medical service: case review and recommendations for retrieval physician training. EmergencyMedicine Journal2014; 31:665-668Athens Access @http://emj.bmj.com/content/31/8/665.abstract.html?etoc

Parents Accompanying Injured Children in Emergency HelicoptersThis non-systematic literature review aimed to examine the impact of parents accompanying theirchildren in an air ambulance after paediatric trauma, in order to assist prehospital clinicians in decidingwhether this is beneficial this patient group. The authors report, although accompaniment is thepreference in emergency transport over land, a lack of published data does not allow a recommendationof parental accompaniment in a helicopter to be mandated. The authors call for further research into the

emotional recovery of children after trauma, and patient, parent and staff experiences during transport.

Cowley A, Durge N. The impact of parental accompaniment in paediatric trauma: a helicopteremergency medical service (HEMS) perspective. Scandinavian Journal of Trauma, Resuscitationand Emergency Medicine 2014, 22 :32Open Access @www.sjtrem.com/content/pdf/1757-7241-22-32.pdf

Shift Alertness of Helicopter Emergency Medical Service CrewThis project aimed to measure in-shift alertness levels amongst HEMS clinical crew members acrossseven 12-hour day shifts at Kent, Sussex and Surrey Air Ambulance Trust. Background data recordedincluded age, gender, role, experience, hours of sleep pre-shift and number of shifts worked in previous3 days. In-shift data included activities since last test and consumption of food and drink. Alertness was

measured every two hours using two computer based tests. The results showed alertness to vary duringthe day shift but that the crew maintained alertness despite fatigue. Background and in-shift activity didnot seem to impact on alertness but in-shift testing was found to be difficult to conduct due to operationalactivities and further research is recommended.

Cullip T, Hudson A, Lyon R et al. Oral presentation - Testing alertness of Helicopter EmergencyMedical Service (HEMS) crewsa feasibility study.Scandinavian Journal of Trauma, Resuscitationand Emergency Medicine, 2014, 22:O1Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-O1.pdf

Stand Downs of a Helicopter Emergency Medical ServiceStanding down of Helicopter Emergency Medical Service crews after deployment renders a vitalresource unavailable whilst costing charities money and requiring crews to take unnecessary risks.This study reviewed data from the Kent, Surrey & Sussex Air Ambulance Trust to identify activationtriggers and reasons for stand down (38% of deployments in the study period). Only 10% were found tobe due to technical issues (including the weather and re-direction); Most occurred at night with peaks atparamedic shift changes. Immediate dispatches accounted for 61%, with 30% resulting afterinterrogation. The authors suggested an improvement in the quality of initial information could reducestand-downs, along with more staff training and developing dispatch criteria.

Evans E, Hudson A, McWhirter E et al. Poster presentation: A review of the activation triggers andreasons for stand downs of a Helicopter Emergency Medical Service (HEMS). Scandinavian Journalof Trauma, Resuscitation and Emergency Medicine 2014, 22:P5Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P5.pdf
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Drug Administration & Treatment

Intraosseous Access in Trauma CareAlthough intraosseous access is an increasingly accepted alternative to peripheral vascular access inadults there is insufficient evidence in large patient groups supporting its use. This retrospective study ofover 1,000 patients investigated its use over a 7-year period during combat operations in Afghanistan.The results showed IO access could be used to administer a wide variety of life-saving medicationsquickly, easily and with low-complication rates highlighting its role as an alternative method of obtainingvascular access, vital when resuscitating the critically injured trauma patient.

Lewis P, Wright C. Saving the critically injured trauma patient: a retrospective analysis of 1000 usesof intraosseous access.Emergency Medicine Journal Published 30 June 2014Athens Access @http://emj.bmj.com/content/early/2014/06/30/emermed-2014-203588.abstract.html?papetoc

Intraosseous Rapid Sequence Induction of AnaesthesiaIntraosseous drug infusion is often used in trauma to obtain rapid, reliable access. This prospectiveobservational study undertaken in a combat hospital in Afghanistan aimed to build upon the few casereports which have described intraosseous infusion to for rapid sequence induction of anaesthesia,assessing its feasibility. Data on drug use was recorded by the prehospital, physician-led Medical

Emergency Response Team and by inhospital physicians. Data for 34 patients showed IO drugadministration to be successfully used for trauma RSI, with a comparable first pass intubation successthan published studies describing the IV route

Barnard EBG, Moy RJ, Kehoe AD et al. Rapid sequence induction of anaesthesia via theintraosseous route: a prospective observational study. Emergency Medicine Journal 24 June 2014Athens Access @http://emj.bmj.com/content/early/2014/06/24/emermed-2014-203740.abstract.html?papetoc

Methoxyflurane for the Treatment of Acute PainThe STOP! randomised, double-blind, multicentre, placebo-controlled study involved 300 patients and

was conducted at six UK sites to evaluate the short-term efficacy and safety of methoxyflurane to treatacute pain in patients presenting to emergency departments with minor trauma. Half of the patentsreceived methoxyflurane, and half a placebo. Pain severity reduction with methoxyflurane wassignificantly more than placebo and the authors note their results suggest that methoxyfluraneadministered via a Penthrox inhaler is an efficacious, safe, and rapidly acting analgesic.

Coffey F, Wright J, Hartshorn S et al. STOP!: a randomised, double-blind, placebo-controlled studyof the efficacy and safety of methoxyflurane for the treatment of acute pain. Emergency MedicineJournal 2014; 31:613-618Athens Access @http://emj.bmj.com/content/31/8/613.abstract.html?etoc

This article is discussed in the following commentary which invites readers to ask interesting and importantquestions

Carley S, Body R. Methoxyflurane is a better painkiller than placebo: but do we want to know more?Emergency Medicine Journal 2014; 31:610 Published Online First: 17 Apr 2014Athens Access @http://emj.bmj.com/content/31/8/610.extract.html?etoc
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Pain Management in Major TraumaOver a 3 week period, this study aimed to gauge the efficacy of pain control in major trauma, determiningthe time taken to get pain under control for 16 patients, looking at the analgesia used and investigatingthe efficacy of prehospital analgesia. An average time of 80 minutes was taken to achieve pain control.A higher time was reported for females than for males, and varying times for IV or oral paracetamol andmorphine, provided individually or in combination. The authors suggest methods to achieve faster andbetter intervention for pain control in major trauma, including a review of pain management in prehospitalservices.

Dodd K, Hudson A, Jarman H. Posterpresentation: A study on the effective management of pain inmajor traumas. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2014,22:P14Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-P14.pdf

Diagnosis, Triage and Intervention

Bispectral Index to Monitor Sedation DepthThis prospective study of mechanically ventilated patients in the prehospital setting examined whetherthe bispectral index of the EEG (BIS) might be useful as a tool to evaluate the depth of sedation. The

results showed a poor correlation between BIS values and clinical assessment of sedation depth, theauthors concluding that its use as a tool cannot be recommended.

Duchateau F-X, Saunier M, Larroque B et al. Use of bispectral index to monitor the depth ofsedation in mechanically ventilated patients in the prehospital setting. Emergency MedicineJournalAthens Access @http://emj.bmj.com/content/31/8/669.abstract.html?etoc

Effective Prehospital Use of Magill ForcepsThis retrospective review of ambulance records in Osaka City aimed to assess characteristics of foreignbody airway obstruction in out-of-hospital cardiac arrest patients transported to hospitals by emergency

medical service personnel, and examine the relationship between prehospital Magill forceps use andoutcomes. The results showed prehospital Magill forceps use to be associated with improved outcome ofbystander-witnessed OHCA patients with FBAO.

Sakai T, Kitamura T, Iwami T et al. Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City. Scandinavian Journalof Trauma, Resuscitation and Emergency Medicine, 2014, 22:53Open Access @www.sjtrem.com/content/pdf/s13049-014-0053-3.pdf

Evaluation of a Heated Ambulance MattressThis experimental Swedish study evaluated the effect of a heated ambulance mattress-prototype on

body temperatures and thermal comfort. Data were collected from 23 participants both inside andoutside a cold chamber, both with and without the heated mattress, during four November days.

Outcomes were back, finger and core body temperature, Cold Discomfort Scale (CDS), anxiety andpersonal experience of the mattresses.Statistical difference between the regular and the heated mattress was found in the back temperaturewhile qualitative analyses of experience showed that the heated mattress was warm, comfortable,provided security and was easier to relax on.

Alx J, Karlsson S, Saveman B. Effect evaluation of a heated ambulance mattress-prototype onbody temperatures and thermal comfort-an experimental study. Scandinavian Journal of Trauma,Resuscitation and Emergency Medicine, 2014, 22:43Open Access @ www.sjtrem.com/content/pdf/s13049-014-0043-5.pdf
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Focused Cardiopulmonary Ultrasound in Prehospital CareThis paper presents two cases from the Helicopter Emergency Medical Services in Denmark whereprehospital physicians trained in cardiac ultrasound (FATE) disclosed significant pathology leading toradical changes for the critical patients course.

Jakobsen LK, Btker MT, Lawrence LP et al. Case report: Systematic training in focusedcardiopulmonary ultrasound affects decision-making in the prehospital setting - two case reports.Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:29Open Access @www.sjtrem.com/content/pdf/1757-7241-22-29.pdf

Prehospital Administration of Packed Red Blood CellsThis retrospective study of data from emergency services including the Queensland Ambulance Serviceexamined the characteristics, interventions and the outcomes of patients receiving packed red blood

cells from a road based, doctor-paramedic trauma response team. The results from 71 patients show theRevised Trauma Score may be a useful tool in determining patients for whom administration of pRBC inan integrated civilian trauma system.

Bodnar D, Rashford S, Hurn C et al. Characteristics and outcomes of patients administered blood inthe prehospital environment by a road based trauma response team.Emergency Medicine Journal2014; 31:583-588Athens Access @http://emj.bmj.com/content/31/7/583.abstract.html?etoc

Prehospital Continuous Positive Airway Pressure for Acute Respiratory Failure:This study reports on the development of an economic model to compare the cost-effectiveness ofprehospital CPAP with standard care for adults presenting to the emergency services with acuterespiratory failure. The model assigned a hypothetical cohort of patients with the probability of intubationor death depending upon their characteristics and whether they had prehospital CPAP or standard care.Analysis showed prehospital CPAP to be more effective than standard care, but more expensive. Theprobability of prehospital CPAP being cost-effective at a 20,000/QALY threshold varied from 35.4% to91.3%. The authors calculate that an ambulance service treating 175 appropriate patients per year couldsave around 11 lives while incurring 241,250 additional costs, treating 2000 appropriate patients peryear could save 124 lives while incurring 876,480 additional costs. The authors report the cost-

effectiveness of prehospital CPAP to be uncertain and current evidence is insufficient to supportwidespread implementation.

Goodacre S, Thokala P. Poster 009: Prehospital Continuous Positive Airway Pressure (Cpap) ForAcute Respiratory Failure: An Economic Analysis.Emergency Medicine Journal 2014; 31:780-781,Athens Access @http://emj.bmj.com/content/31/9/780.2.abstract?etoc

Prehospital Differentiation Between Cardiac and Obstructive Causes of DyspnoeaTo assist the prehospital differentiation between cardiac and obstructive causes of dyspnoea, thisretrospective study of 106 patients aimed to assess whether differences in prehospital levels of end-tidalcarbon dioxide (ETCO2) in obstructive compared to cardiac causes of dyspnoea might suggest onediagnosis over the other. Lower levels of ETCO2 were found to be associated with CHF. The authorssuggest this may serve as an objective diagnostic adjunct to predict this cause of dyspnoea in theprehospital setting.

Hunter CL, Silvestri S, Ralls G et al. Prehospital end-tidal carbon dioxide differentiates betweencardiac and obstructive causes of dyspnoea.Emergency Medicine Journal Published 1 July 2014,doi:10.1136/emermed-2013-203405Athens Access @http://emj.bmj.com/content/early/2014/07/01/emermed-2013-203405.abstract.html?papetoc
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Prehospital Haemorrhage ControlHaemorrhage following major injury remains the most common potentially preventable cause oftraumatic death with exsanguination typically occurring within three hours of injury.A care bundle of measures to facilitate early diagnosis, rapid haemorrhage control, systemic andtopical haemostatic support and short scene times are key to improving outcomes.A paradigm shift in treatment strategies and transfusion algorithms over the last decade has seenemphasis on haemostatic or damage control resuscitation (DCR).This article focuses on advanced interventions without discussing the fundamentals of prehospitalhaemorrhage control.

Davenport R. Extended abstract - Haemorrhage control of the prehospital trauma patient.Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2014, 22:A4Open Access @www.sjtrem.com/content/pdf/1757-7241-22-S1-A4.pdf

Prehospital Non-Invasive Ventilation for Acute Respiratory FailureA systematic review of literature was undertaken to determine the effectiveness of prehospitalcontinuous positive airway pressure (CPAP) or bi-level inspiratory positive airway pressure (BiPAP)compared with usual care for adults presenting to the emergency services with acute respiratory failure.Eight randomised and two quasi-randomised controlled trials were identified from the literature and a

meta-analysis of the r