British Paramedic Journal

College of Paramedics Research Conference 2024: Oral abstracts

Graham McClelland — 2024-09-02

Accepted oral abstracts from the College of Paramedics Research Conference 2024 including dragons den abstracts. For posters from the conference please go to the Library and Knowledge Service (LKS) for NHS Ambulance Services in England https://amber.openrepository.com/handle/20.500.12417/1746 ]

The effects of homeworking on 999 clinicians’ wellbeing during the COVID-19 pandemic.

Edward Harry — 2024-09-02

Abstract

Purpose – The COVID-19 pandemic has significantly stressed global healthcare provisions since its discovery in 2019. United Kingdom ambulance services had to adapt and change their working practices to meet distancing requirements, increase staff numbers and ease the effects of staff becoming unavailable for work due to self-isolation and illness. One such strategy was moving clinicians from Emergency Operation Centres (EOCs) to working at home. Like many international services, UK ambulance services use paramedics and nurses to undertake telephone and video assessments of patients calling the 999-emergency services line in a model known as virtual care or remote clinical decision-making. Virtual care is any interaction between a patient and clinician or clinicians, occurring remotely using information technologies.

Increasing evidence is becoming available to suggest that the pandemic caused harm to the well-being of healthcare workers, primarily due to the severe stress of regular exposure to death and human suffering (Marczewski et al., 2022). However, there remains a dearth of literature focusing on the well-being of remote and virtual clinicians, especially those who moved from working in EOC to working at home during the COVID-19 pandemic. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, well-being, and leadership practices of those delivering such services.

Design/methodology/approach - A convenience sample of telephone nurses and paramedics from one UK ambulance service where homeworking had been implemented were contacted. Fifteen clinicians with recent home-working experience responded to the invite out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video conferencing software and were recorded, transcribed, and thematically analysed. An inductive approach was taken to generating codes, and both researchers separately read the transcript before re-reading them, assigning initial themes, and determining frequency.

Findings - Five main themes were discovered with further associated sub-themes: 1) Safety. 2) Financial Implications. 3) Working relationships. 4) Home-working environment and 5) Anxiety.

Originality/Value - Few studies explore remote clinicians' health and well-being. This study identified that home-working clinicians felt that there had been no detrimental impact on their health and well-being because of working from home during the initial phase of the COVID-19 pandemic. Whilst some concerns were raised, these were mitigated through the support they received at home with family members and colleagues – some of whom participants had developed new working relationships. Financial concerns appeared to have contributed to some concerns with participants initially but had been alleviated quickly despite requiring further exploration of the true financial impact of working from home.

Keywords: Home-working, telephone consultation, Health, Well-being, Pandemic 999, Ambulance, Remote.

Paper Type Research.

Comparing Independent Prescribing to Patient Group Direction Use in a General Practitioner Out of Hours Service: A Retrospective Cross-Sectional Study.

Hayley Stevens — 2024-09-02

Introduction: Since its introduction in 2018, only 3.2% of British paramedics are registered as independent prescribers (HCPC, 2021). Alternatives such as patient group directions (PGDs) currently facilitate non-emergency medication provision.

An opportunity to compare PGD use to independent prescribing is offered by advanced paramedic practitioners (APPs) rotating through Ambulance and General Practitioner Out of Hours (GPOOH) Services. APPs use PGDs to provide medications, the nurses working alongside them in the GPOOH service prescribe. With GP and governance support, this model of working meets College of Paramedic prescribing guidance, allowing implementation if a need to prescribe is demonstrated.

Objectives:

Compare medications prescribed/supplied by nurse prescribers and APPs
Compare how patients receive medication (PGD, prescription or verbal order)
Compare the reasons verbal orders were sought

Method: Using a retrospective, cross-sectional design, notes of 397 patients who presented to a nurse prescriber or an APP with one of five specified conditions, were reviewed.

Results:

Nurses prescribed medication independently in 99.3% of consultations.
In 68.2% of consultations, APPs required the support of a prescriber to complete the consultation.
Main reasons for gaining prescriber support included: no PGD available for medication given (34.1%); PGD exclusion criteria applied (28.4%).
Nurses prescribed more non-PGD medications than APPs supplied under verbal order from prescribing colleagues, although the difference was not statistically significant (30.5% vs. 23.3%).

Conclusion: Using a mix of verbal orders and PGDs, APPs can supply a similar level of medication as prescribing nurses. However, this requires substantial prescriber support, is costly, and delays patient access to medication. PGD use alone cannot meet patient demand in this GPOOH service.

APPs using PGDs can only be autonomous up to 37.5% of the time. Nurse prescribers are autonomous 99.3% of the time. Therefore, independent prescribing provides the autonomy needed to treat most common ailments independently, demonstrating a need to prescribe in this service.

Influence of Patient Body Weight on the Probability of Return of Spontaneous Circulation Following Out-of-Hospital Cardiac Arrest: An Exploratory Analysis

Michael Hubble — 2024-09-02

Introduction: In addition to key interventions including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race, and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA despite globally increasing obesity rates.

Objective: To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA.

Methods: This retrospective study included adult patients from a national EMS patient record with witnessed, non-traumatic OHCA prior to EMS arrival from January 2020-December, 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC.

Results: Complete records were available for 9,096 patients, of which 64.3% were males and 25.3% were minorities. The mean age of the participants was 65.01(±15.8 SD) years with a mean weight of 93.52 kg(±31.5 SD). Altogether, 81.8% of arrests were of presumed cardiac etiology, and 30.3% presented with a shockable rhythm. Layperson CPR and AED defibrillation were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100kg(OR=0.709, p<0.001), male sex(OR=0.782, p<0.001), and increasing age and EMS response time(OR=0.994 per year, p<0.001 and OR=0.970 per minute, p<0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC(OR=1.790, p<0.001) as were patients receiving layperson CPR(OR=1.170, p<0.001) and defibrillation prior to EMS arrival(OR=1.658, p<0.001). Although the mean first epinephrine dose(mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total epinephrine dose administered to achieve ROSC demonstrated an upward linear trend of 0.05mg for every 5kg of body weight.

Conclusions: Patient weight was negatively associated with ROSC and positively associated with the total epinephrine dose required to attain ROSC.

Introduction of a section for recording dementia improves data capture on the ambulance electronic patient record: evidence from a regional quality improvement project

Carole Fogg — 2024-09-02

Background: Dementia is a common comorbidity in older people who require urgent or emergency ambulance attendance and influences clinical decisions and care pathways. Following an initial audit of dementia data and consultation with staff, a specific section (tab) to record dementia was introduced on an ambulance service electronic patient record (ePR). This includes a dementia diagnosis button and a free text section. We aimed to assess whether and how this improved recording.

Aims: To re-audit the proportion of ambulance ePRs where dementia is recorded for patients aged ≥65 years and describe the frequency of recording in patients aged <65; to analyse discrepancies in the place of recording dementia on the ePR by comparing data from the new dementia tab and other sections of the ePR.

Results: We included 112,193 ePRs of patients aged ≥65 with ambulance attendance from a 6 month period. The proportion with dementia recorded in patients aged ≥65 was 16.4%, increasing to 19.8% in patients aged ≥75, as compared to 13.5% and 16.5% in our previous audit. Of the 16.5% (n=18,515) of records with dementia, 69.9% (n=12,939) used the dementia button and 25.4% (n=4,704) recorded text in the dementia tab. Dementia was recorded in ePR free text fields (but not the dementia tab) in 29.7% of records. Eighteen other free text fields were used in addition to, or instead of, the dementia tab, including the patient’s social history, previous medical history and mental health. Dementia was present on the ePR of 0.4% (n=461) of patients aged <65.

Conclusions: An ePR dementia tab enabled ambulance clinicians to standardise the location of recording dementia and may have facilitated increased recording. We would recommend other ambulance Trusts capture this information in a specific section to facilitate information sharing and inform care planning for this patient group.

The zero-responder: a definition and report of current literature

Eloise Graham — 2024-09-02

Introduction

The term ‘zero-responder’ was initially devised in 2010 to describe those passing by or unharmed in a mass casualty incident who provide life-saving care for injured persons before qualified professionals arrive. This review aims to determine how the literature defines the role of zero-responder and whether this definition is applicable for modern practice.

Methods

A thorough literature search of the Ovid Medline, Embase, APA PsychInfo, PubMed, Web of Science, and Scopus databases discovered seven relevant papers discussing the role of the zero-responder. Using the University of Birmingham library catalogue and a forward citation search using Google Scholar found additional papers, meaning twelve relevant papers were found overall.

Results

Insufficient literature and data were discovered to permit a comprehensive literature review. However, a persistently quoted definition of zero-responder was located, as well as several papers exploring this term.

Discussion

The current definition of zero-responder doesn’t reflect modern expectations of the role. A revised definition is suggested to clarify the role as relating to medical responses to terrorism incidents. This article explores how the role of the zero-responder can be facilitated through authority recognition and equipment provision.