British Paramedic Journal

The Weight of the Elephant(s): Rethinking the Tyranny of Tradition in Modern Paramedic Education

2026-07-22T12:14:47+01:00

Editorial

Editorial Board News and a Celebration of Paramedic Research

2026-07-22T13:10:08+01:00

Investigating the Impact of Community First Responders on Out-of-Hospital Cardiac Arrest Outcomes in the North East of England: A Retrospective Cohort Study

2026-04-28T10:43:38+01:00

Background: Community First Responders (CFRs) are integrated within UK ambulance services to deliver early life-saving interventions prior to emergency medical service (EMS) arrival. Although CFR attendance is associated with earlier cardiopulmonary resuscitation (CPR) and defibrillation, evidence regarding their independent impact on survival following out-of-hospital cardiac arrest (OHCA) remains mixed, and regional data from North East England are limited.

Aim: To evaluate the association between CFR attendance and survival outcomes following OHCA attended by a single NHS ambulance service.

Methods: A retrospective cohort study was conducted using anonymised adult OHCA data from the North East Ambulance Service between November 2020 and October 2025. The analytic cohort included all cases receiving advanced life support (ALS) and basic life support (BLS)–only cases that achieved return of spontaneous circulation (ROSC), representing viable resuscitation attempts. Cases were categorised by CFR attendance. The primary outcome was survival to hospital discharge. Secondary outcomes included OHCA characteristics, bystander interventions, EMS treatments, and ROSC. Multivariable logistic regression was used to adjust for established Utstein predictors and system-level factors.

Results: A total of 7,916 OHCA cases were included, of which 177 (2.2%) involved CFR attendance. CFR-attended cases were more likely to occur in rural locations and were associated with longer ambulance response times. Public-access defibrillation was more frequent in CFR-attended cases (20.3% vs 12.2%, p=0.001), while bystander CPR rates were similar between groups. Survival to hospital discharge did not differ significantly between CFR and non-CFR cases (9.6% vs 10.2%, p=0.797). After adjustment, CFR attendance was not independently associated with survival to hospital discharge (adjusted OR 1.15, 95% CI 0.51–2.61).

Conclusion: CFR attendance was associated with improved early resuscitation processes but not with increased survival to hospital discharge after adjustment. These findings suggest that CFRs strengthen the early links of the chain of survival, while longer-term outcomes remain influenced by downstream system and clinical factors. Further research incorporating more granular CFR-specific data is required to better characterise their contribution to OHCA outcomes.

Advanced Paramedic Paralysis in ROSC (APPiR) Study

2026-02-19T19:36:48+00:00

Abstract

Background

Some patients who have an out of hospital cardiac arrest (OHCA) will achieve a return of spontaneous circulation (ROSC), but many will show no signs of awareness prehospital. For a subset of patients who begin to show signs of awareness and distress, Advanced Paramedic Practitioners in Critical Care (APP) can administer analgesia and sedation. Additionally, for patients who have already had an endotracheal tube (ETT) placed, APPs may administer a neuromuscular blockade (NMB) agent to paralyse respiratory muscles - where there is poor tolerance to the ETT and ventilatory control is required.

Methods

A retrospective cohort study was conducted for all occasions where APPs administered a NMB agent over a one year period. Variables were collected that informed the circumstances in which NMB occurred. Furthermore, relevant patient vital signs were scrutinised for the ten minute period before and after administration to establish possible physiological trends.

Results

APPs administered NMB on 99 occasions. Most patients were male and younger than the average OHCA patient. Most patients had a witnessed arrest and bystander CPR. Over half the group presented with a shockable rhythm. Median time to NMB was 71 minutes from OHCA and 28 minutes prior to the arrival at hospital. All APP endotracheal intubation occurred within two attempts. There was no statistically significant adverse shifts in oxygen saturations, end tidal carbon dioxide, mean arterial pressure and heart rate observed.

Conclusions

Despite the challenges and the many variables involved in managing OHCA ROSC patients, APPs were able to administer NMB within an authorised scope and without adversely affecting physiological measurements. Comparative prehospital systems may find this data useful to help inform their own critical care scope of practice.

Closing the Gap: Staff Perspectives on the Effectiveness of Teleconsultation in Prehospital Emergency Care – A Qualitative Study

2026-05-17T16:42:52+01:00

Background:
Teleconsultation is increasingly used within prehospital emergency care to provide remote clinical support for paramedics and patients. Despite its growing integration into healthcare systems, there is limited empirical research exploring paramedics’ lived experiences of teleconsultation and the factors shaping its effectiveness in practice.

Aim:
To explore paramedics’ perspectives on teleconsultation in prehospital care and identify the mechanisms influencing its effectiveness.

Methods:
A qualitative study was conducted using semi-structured interviews with 12 paramedics working in critical care and clinical advisory roles within a large NHS ambulance trust in England. The study was grounded in Bhaskarian transcendental realism, commonly referred to as critical realism in applied health research. Data were analysed using a critical realist thematic approach, combining reflexive thematic analysis with abductive and retroductive reasoning to identify underlying mechanisms.

Results:
Three interrelated mechanisms were identified. First, a Teleconsultation Competence Gap reflected insufficient preparation for remote consultation within paramedic education and training. Second, Environmental Determinism highlighted the influence of organisational culture, leadership and workload on practitioners’ experiences. Third, an Autonomy–Governance Balance captured tensions between clinical autonomy and oversight, particularly where governance processes were perceived as punitive rather than supportive. These mechanisms operated differently across contexts, shaping both practitioner confidence and engagement with teleconsultation.

Conclusion:
Teleconsultation in prehospital care is shaped by interacting educational, organisational and governance mechanisms. Addressing these collectively, through targeted training, supportive working environments and transparent governance, may enhance paramedic confidence, improve service effectiveness and support patient-centred care.

The role and work of Paramedics in Cornwall: a cross-sectional online survey

2026-02-01T15:58:16+00:00

The role and work of Paramedics in Cornwall: a cross-sectional online survey

Sophy Savage*

Abstract

Introduction: General practice faces increasing pressure, especially in deprived rural areas (Laccobucci 2019). The Additional Roles Reimbursement Scheme (ARRS 2019) was introduced to employ extra health professionals, including paramedics, to support the delivery of general practice services. In Cornwall, over 60% of general practices employ paramedics, as identified in a preliminary search of GP websites by the author. However, it was unclear what roles and tasks they undertook and how they were funded. This study’s aim, the first to focus on a specific rural area in the UK, was to explore these questions.

Method: Data from a cross-sectional online survey were collected between June and September 2024. Participants were HCPC-registered paramedics in general practice in Cornwall. They were invited to complete the survey via the Cornwall Primary Care Training Hub. Quantitative data were analysed using descriptive statistics, while qualitative free-text responses were collated and examined for patterns.

Results: Of the sixty-two invitees, 37 provided valid responses (60%). Fourteen (38%) were non-medical prescribers. Thirteen (35%) were ARRS funded, and thirteen different job titles were used. All of them saw patients identified as urgent in a clinic or at home; 4 (11%) were employed specifically as part of a home visiting team, and 4 (11%) as members of a multidisciplinary hub/same-day service.

Conclusion: This was the first survey to investigate the roles and work of paramedics in general practice within a specific area of the UK. It highlighted training needs, raised questions about employment models, non-medical prescribing, funding, and job titles. Addressing some of these questions would provide greater clarity and increase recognition of the paramedics' role in general practice, while also potentially informing workforce planning.

Keywords: Paramedic, General practice, General practitioner, Additional Roles Reimbursement Scheme, non-medical prescriber.

*Corresponding author.

Sophy Savage, St Agnes Surgery, Pengarth Road, St Agnes, Cornwall, TR5 0NT.

Email: sophy.savage1@nhs.net

Word count – abstract including Key words 286, Main body 2,828 excluding tables.

FPHC Wellbeing: Pregnancy, maternity and return to work guidelines

2025-12-08T22:52:11+00:00

Background

In 2022 the Faculty of Pre-hospital Care (FPHC) report on “Valuing Staff, valuing patients” was published, outlining the need to “seek out and remedy secondary stressors”, such as training burdens or financial costs. As part of developing a FPHC wellbeing charter addressing such stressors, focus groups and survey responses identified the lack of guidelines surrounding maternity, pregnancy and return to work as a key stressor in the pre-hospital setting. The aim is therefore to outline the FPHC guidelines for pregnancy, maternity and return to work following this.

Methods

Questionnaires and focus groups responses, alongside a literature search were utilised. This was led by the FPHC wellbeing group. Additionally, responses from conferences and author contacts were incorporated. Participants were sought from a range of pre-hospital organisations including National Health Service ambulance trusts, air ambulance organisations and voluntary organisations such as Mountain Rescue to ensure representation. This guideline has been reviewed by the FPHC executive board.

Results

All pre-hospital organisations require a maternity and parental-leave policy to be in place. Autonomy and individualised risk assessments are highly recommended. Alongside these legal requirements relating to breast-feeding on the return to work must be met. Personalised return to work programmes for individuals after a period of maternity or parental leave should exist.

Conclusion

The FPHC pregnancy, maternity and return to work guidelines outline recommendations for pre-hospital organisations in how to meet the legal requirements, whilst also ensuring employees/volunteers choice, autonomy and active involvement in this process.

In patients with cardiopulmonary induced consciousness in cardiac arrest in the prehospital setting, does the use of pharmacological interventions impact mortality compared to standard care? A systematic review

2026-02-01T15:36:25+00:00

Abstract:

Background:

Cardiopulmonary induced consciousness (CPRIC) is the term commonly used to refer to signs of life displayed by patients during resuscitation. This phenomenon presents a challenge as these signs of life can interfere with resuscitative efforts. International resuscitation guidelines currently do not recommend a specific treatment strategy.

Aims and objectives:

This systematic review aimed to ascertain whether pharmacological management of adult cardiac arrest patients with CPRIC in the prehospital setting had an impact on mortality rates compared to standard care. The review also aimed to identify any association between use of specific pharmacological agents and mortality.

Design and methods:

Studies that reported on adult cardiac arrest patients presenting with CPRIC who received pharmacological management and were resuscitated in the prehospital setting were included. The literature search excluded studies that did not provide mortality data. The search was conducted using PubMED, CINAHL and Embase. A narrative synthesis approach was used to report the results.

Main results:

Two studies were identified by the literature search. Both articles were Australian retrospective observational cohort studies that included a total of 39,569 patients, of which 164 presented with CPRIC. Patients with CPRIC were found to be more likely to survive than those who did not. Patients who were managed with medications had a lower survival rate than those who did not. Due to limited and heterogeneous data, a meta-analysis was not conducted.

Conclusion:

The evidence produced included a significant number of confounding factors, limiting both internal and external validity of this review. Overall, the confidence in the results is low and the findings cannot be generalised to clinical practice. This review did however highlight the need for further research on the prehospital management of CPRIC. This is especially emphasized by increases in mortality in those treated with midazolam, and by the fact that the only available evidence pertains to midazolam, despite an increasing prevalence of other agents being used.

A Letter to the Editor, BPJ

2026-06-18T15:47:09+01:00

Not applicable

Optimising Emergency Ambulance Patient Flow for Children Aged 0–4 with Breathing Problems: A Service Evaluation of the Paediatric Respiratory Emergency Prioritisation (PREP) within x Ambulance Service.

2026-03-23T13:20:57+00:00

Title:
Optimising Emergency Ambulance Patient Flow: A Service Evaluation of the Paediatric Respiratory Emergency Prioritisation (PREP) Score for Children with Breathing Problems in x Ambulance Service.
Objectives
To assess the operational value of the Paediatric Respiratory Emergency Prioritisation (PREP) Score, a caller-reported triage tool for children aged 0–4 years with breathing problems and explore whether it could reduce over-triage without compromising safety.
Design
Service evaluation using routinely collected data.
Setting
x Ambulance Services, focusing on emergency calls coded MPDS 06E01 (“Breathing Problems”) between September 2022 and May 2025.
Population
5,935 emergency cases involving children aged 0–4 years with a completed clinical record.
Methods
Caller-reported features (consciousness, airway, breathing pattern, distress, medical history, and MPDS suffix) were combined to create the PREP Score. Standard checks of calibration, discrimination, and reliability were applied, and the score was tested on a separate dataset to explore operational usefulness.
Results
The PREP Score showed consistent performance, with moderate ability to distinguish higher- from lower-acuity cases (AUC 0.73, 95% CI: 0.70–0.77) and strong calibration (mean absolute error 0.004). At a conservative threshold, sensitivity was 53% and negative predictive value 93%, supporting safe identification of lower-risk cases. Around 38% of children scored zero, suggesting scope to reduce unnecessary emergency responses. When applied to the busiest month of the study period, PREP would have released an estimated 700 ambulance hours, highlighting its potential to improve efficiency.
Conclusions
As part of this service evaluation, PREP demonstrated promise as a caller-reported triage support tool. It complements the existing MPDS system and may improve patient flow within x by reducing over-triage. Further exploration in other settings would be needed before wider adoption, but PREP illustrates how locally developed tools can support safe and efficient ambulance responses.
Keywords:
Respiration, Child, Triage.

The HART PLAsMa Trial: Addressing Recommendation 120 from the Manchester Arena Inquiry with the UK’s First Hazardous Area Response Team Pre-Hospital Blood Transfusion Capability

2025-10-20T17:22:54+01:00

Background

Pre-Hospital Blood Products (PHBPs) are carried by the majority of UK pre-hospital Enhanced and Critical Care Teams (ECCTs). These teams do not have safe systems of work (SSoW) to operate within the highest risk areas of a major incident (MI). The Manchester Arena Inquiry recommended that ‘the Faculty of Pre-Hospital Care, the College of Paramedics and the National Ambulance Resilience Unit consider whether all Hazardous Area Response Team (HART) paramedics should be deployed with freeze-dried plasma and trained in its use’. The aim of the HART Pre-hospital Lyoplas Administration for Major haemorrhage (PLAsMa) trial was to address this recommendation.

Methods

This 12-month trial was conducted as a service evaluation with aspects of clinical audit. Prospectively determined outcome, process and balancing measures were used to assess safety, cost and clinical care compliance to a HART Major Haemorrhage protocol (MHP). Data were analysed and presented using descriptive statistics.

Results

Lyoplas was administered 17 times in total during the trial year, 12 times at HART led incidents and 5 times in support ECCTs. 12/13 (92.3%) of consultant authorisations to administer Lyoplas were correctly indicated according to the HART MHP. The correct number of units of Lyoplas were administered in 11 out 12 (91.7%) of cases.

At HART led incidents, patients received oxygen in 10/12 (83.3%) cases and Tranexamic Acid in 11/12 (91.7%) cases. Patients with cardiac output received active warming in 5/9 (55.6%) cases and 1 case of maternal haemorrhage received uterotonic. No adverse incidents were reported.

Conclusion

Our trial demonstrated that it is feasible to set up a HART PHBP capability. It has also shown with a small number of cases that HART paramedics, with an online training package, remote Top Cover support and a mandated MHP, were able to identify eligible patients for PHBP transfusion and carry out safe administration.