British Paramedic Journal

Editorial: A year of growth and opportunity

2025-12-09T18:07:16+00:00

Between the Ambulance and Academia: Rethinking Competence and Identity in Paramedics with Reduced Clinical Exposure

2025-11-27T12:48:30+00:00

A letter to the Editor: Expanding the evidence base for ventilation feedback devices

2025-09-17T15:17:14+01:00

Mapping prehospital research presented at UK conferences between 2010 and 2023: a bibliometric study

2025-08-19T00:19:33+01:00

Introduction

The growth of the paramedic profession over recent years is reflected in the growing body of publications by paramedics or related to paramedics, ambulance services and prehospital care. Publications are not the only method by which new knowledge can be disseminated and conferences represent another method of dissemination. Conference presentations may, or may not be published, so studying conference publications presents a different perspective on topics of interest and research happening within the profession. This study set out to report on material presented at large conferences relevant to UK paramedics between 2010 and 2023.

Methods

A bibliometric study describing presentations from UK conferences relevant to paramedics between 2010 and 2023. Conferences relevant to paramedic practice were selected by the study team based on predetermined criteria. Standardised forms were used to extract data on presentations and presenters. Data are presented descriptively.

Results

Six large conferences (999 EMS Research Forum, Ambulance Leadership Forum, Faculty of Prehospital Care conference, College of Paramedics National conference, Research conference and Student conference) were selected and data from 43 individual conferences were collected representing 70% of the potential conferences in this time.

The data includes 690 presentations given by 551 individual presenters. Paramedics were the most common professional group presenting. The London Ambulance Service, North East Ambulance Service and University of Sheffield were the most common institutions. The most common topics were policy and practice, research and trauma. The most common methodologies qualitative.

Conclusion

This study provides an overview of research presented at paramedic, ambulance service and prehospital conferences. A wide range of research was presented at the selected conferences by many individuals. A wide range of topics feature in the data but high impact, low frequency clinical conditions such as cardiac arrest and major trauma feature highly.

The prevalence of burnout in UK emergency ambulance staff: A mixed methods survey study

2025-05-06T08:28:54+01:00

Background: Work related burnout is a serious and frequently documented issue affecting the mental health and wellbeing of a large proportion of people, namely ambulance service personnel. Owing to the nature of their emergency services role, ambulance service professionals are frequently exposed to highly demanding and stressful situations, resulting in stress and subsequent burnout. In addition, the causal link between burnout, depression, anxiety, and subsequent suicidal ideation highlights the importance of burnout research amongst ambulance personnel. As a result, the aim of this study was to discuss the incidence of burnout within one ambulance service in the North of England, UK.

Methods: This single ambulance service study was a mixed-methods survey study with data collection utilising the nineteen-question Copenhagen Burnout Inventory (CBI) which measures burnout across three domains: personal burnout, work related and patient related burnout. The questionnaire was amended to incorporate a free text space to provide opinions on causation of burnout alongside suggestions of how current practice can be improved.

Results: Seventy-eight staff members completed the questionnaire. Thirty-eight (48.7%) staff members were found to be experiencing personal burnout, forty-two (53.8%) staff members experienced work-related burnout, and patient related burnout was found in twenty-nine (37.1%) respondents.

Within the questionnaire four themes were identified through thematic analysis: external factors; patterns of work; management support and sickness absence.

Conclusion: Findings suggest that burnout is prevalent within this Trust. This requires further investigation into causation alongside consideration towards preventative measures and interventions that improve emergency medical service (EMS) wellbeing as literature suggests that burnout is associated with declining mental health and increased staff sickness absence rates.

A randomised, exploratory study comparing a single episode of feedback with regular feedback and no feedback on ambulance clinician bag valve mask ventilation during a simulated cardiac arrest over a six-month time frame

2025-10-20T20:24:11+01:00

Introduction

Ventilation with a bag valve mask (BVM) is a standard part of cardiopulmonary resuscitation (CPR) performed by ambulance clinicians. Ventilation quality has received little attention until recently when ventilation feedback devices (VFDs) have become available. Evidence suggests clinicians struggle to ventilate according to guidelines without feedback and that a VFD improves ventilation quality. This study explored the impact of regular VFD use compared with a single episode of VFD use and no VFD use on ventilation quality during simulated CPR across a six-month period.

Methods

A single site, exploratory, randomised controlled trial conducted in North East Ambulance Service. Participants completed six-minute CPR scenarios, with ventilation quality recorded, repeated three times over six-months. Participants were randomised 1:1:1 to either ventilation feedback at each session, feedback at the first session only, or no feedback (control). The primary outcome was ventilation quality (rate and volume) at the final study session.

Results

The study ran February to July 2025 and included 51 participants, mostly (82%) male, median age 39 years (IQR 33-45) and primarily (92%) paramedics. Participants completed 150 study sessions generating 15.5 hours of ventilation data. There was a clear difference in ventilation quality (rate and volume) with VFD versus no VFD. The ventilation quality of the group which had feedback at only the first session declined sharply when feedback was removed and by the third (final) study session the group was statistically no different from the control group. VFD use reduced hyper- and hypoventilation.

Conclusion

This exploratory randomised controlled trial demonstrates that VFD use improves the ability of ambulance clinicians to ventilate according to guidelines but when the VFD is removed, they rapidly revert to a low level of compliance. Future work needs to study VFD use in clinical practice and explore any impact on patient outcomes.

Ambulance Service Demand from Prisons: A Service Evaluation

2025-07-25T10:22:01+01:00

Background: People in prison experience substantial health inequalities, including a higher prevalence of physical and mental health conditions, substance misuse and increased mortality. Despite these vulnerabilities, little is known about ambulance service activity involving the prison population. There are 13 prisons in the region served by Yorkshire Ambulance Service (YAS) NHS Trust: 10 male adult prisons, 1 male young offender prison and 2 female prisons. The aim of this service evaluation was to understand the current level of demand and patient disposition when emergency ambulance calls are made from prisons.

Methods: This service evaluation used retrospective data from YAS dispatch records for emergency calls for adult (≥ 18 years) remanded in prisons within the Yorkshire and Humber region. Data were collected for calls made between 1st April 2021 and 31st March 2022, including call reason, patient disposition (e.g., transported, non-transport) and total time on scene. Publicly available Ministry of Justice statistics on prison populations were also consulted for context. Descriptive analyses were performed using counts, proportions, means, medians and confidence intervals. Comparative conveyance rates were calculated relative to overall YAS call activity during the study period.

Results: There were 1,263 calls to YAS from prisons during the study period, with at least one ambulance resource sent to 1,025 calls. Such calls accounted for 0.1% of the total YAS call volume and 0.14% of incidents attended by a YAS vehicle. A total of 730 incidents resulted in a conveyance from prison, representing a 71.2% conveyance rate, which was approximately one-third higher than the overall conveyance rate by YAS during the study period.

Conclusions: Calls to the ambulance service from prisons represent a small proportion of overall workload in the Yorkshire and Humber region. Despite this, both attendance and conveyance rates were higher for calls originating from prisons compared to the general population.

Evaluating the Impact of Demographic and Deprivation Factors on Paramedic-led Analgesia: A Service Evaluation

2025-08-03T11:35:56+01:00

Background

Prehospital pain is prevalent and frequently undertreated. Limited UK-based research has examined the influence of demographic and deprivation factors on paramedic-delivered analgesia. Early effective management of acute pain has been shown to improve patient satisfaction and outcomes. Hence, evaluating the efficacy of such is important given the limited formulary paramedics access, combined with the diverse communities paramedics serve.

Methods

A retrospective observational service evaluation was conducted using anonymised adult (18+) clinical record data. This was collected from the North East Ambulance Service NHS Foundation Trust for the period of 01/07/23 to 30/06/24. The primary outcome was the achievement of the minimum clinically important difference (MCID: ≥2-point or 30% reduction) and adequate analgesia (AA: ≥50% reduction) on the 11-point numeric pain scale (NRS-11). Outcomes were compared across gender, age, and index of multiple deprivation (IMD) decile.

Results

Of 54,998 eligible cases, the MCID was achieved in 41.98% and AA in 24.76% of patients. As social deprivation increases, patients become significantly less likely to achieve the MCID or AA (MCID: ρ = 0.81, 95% CI: 0.39, 0.96, p = 0.007; AA: ρ = 0.88, 95% CI: 0.56, 0.97, p = 0.002). Male patients were marginally more likely to achieve AA than female (1.13%, 95% CI: 0.40, 1.86%, p = 0.002). Increasing age correlated strongly with both MCID (ρ = 0.90, 95% CI: 0.74, 0.96, p < 0.001) and AA (ρ = 0.90, 95% CI: 0.75, 0.96, p < 0.001) achievement.

Discussion

Paramedic-led analgesia is associated with a pain reduction in most cases, however the magnitude of this reduction varies. Increased age, lower social deprivation, and the male gender were associated with greater reported analgesic efficacy. The reasoning for this is unclear. Further research to determine causality and inform practice in prehospital pain management are required before definitive conclusions can be drawn.

End-tidal Carbon Dioxide Monitoring to Predict Haemorrhagic Shock and Subsequent Need for Blood Transfusions in Adult Prehospital Trauma Patients: A Systematic Review.

2025-06-08T15:43:15+01:00

Background:

Traumatic haemorrhage is a major cause of preventable death, and blood transfusion (BT) is a crucial component of damage control resuscitation. Several diagnostic strategies exist to anticipate haemorrhagic shock (HS) and subsequent BT requirement, but their prehospital utility is inconsistent. Capnography or end-tidal carbon dioxide (etCO2) measurement has received growing recognition for prognostic capability in metabolic, respiratory, and cardiac disease. This systematic review examines etCO2 efficacy in predicting HS and subsequent BT in prehospital adult trauma patients.

Aims & Objectives:

To determine if early etCO2 measurement in prehospital adult trauma patients can reliably predict HS and/or BT when compared to existing strategies and scoring tools, and to identify if an etCO2 predictive threshold can facilitate this.

Methods:

A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Seven electronic databases were searched using relevant indexed terms and keywords. Inclusion criteria were adult (>13 years) trauma patients with suspected or confirmed haemorrhage with early (pre-diagnostic) etCO2 data from nasal or side-stream devices, in peer-reviewed publications. All articles (n=1359) were double-blind screened at abstract and title, then at full-text stage by two reviewers. Issues were discussed by the authors. Critical appraisal used Critical Appraisal Skills Programme (CASP) tools. Findings were narratively synthesised.

Results:

Twelve articles were included. Significant heterogeneity, quality limitations, and inconsistent reporting hindered direct comparison of results. Nevertheless, ten comparator strategies/tools were identified and the majority of studies demonstrated etCO2's efficacy in predicting HS/BT, with thresholds below 35mmHg consistently suggested as predictive.

Conclusions:

A universal definition for major blood transfusion is still lacking. Further research is needed to identify accurate markers of haemorrhage, including etCO2 as a potential predictor. A high index of suspicion for haemorrhage and need for blood transfusion is recommended for adult trauma patients with etCO2 levels below 35mmHg.