Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians

Vopelius-Feldt, Johannes von; Benger, Jonathan

doi:10.1136/emermed-2013-202895

Cited by 45 publications

(45 citation statements)

References 19 publications

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“…If the standard ALS algorithm has not resulted in a return of spontaneous circulation (ROSC) by the time the CCT reaches the scene, the CCT can provide additional therapies in special circumstances such as drug overdose, electrolyte disturbances or traumatic cardiac arrest. 12 However we excluded cases known to be of noncardiac aetiology, since these causes of OHCA are infrequent and represent very specific groups of patients that might influence survival rates disproportionately. 29 If ROSC has been achieved after OHCA of cardiac aetiology, the CCT can provide advanced cardiovascular support as well as pre-hospital anaesthesia in agitated patients.…”

Section: Discussionmentioning

confidence: 99%

“…12 A detailed analysis of the competences of GWAS and GWAA pre-hospital providers has been published previously. 12 During the study period, the CCT was dispatched via a dedicated special operations desk manned by an experienced dispatcher. The dispatcher scans all incoming calls and weighs up the potential benefits of CCT dispatch together with the CCT.…”

Section: Great Western Air Ambulance (Gwaa) Critical Care Teammentioning

confidence: 99%

“…3 In addition to ALS providers, many EMS have also established targeted dispatch of physicians and/or specialised critical care paramedics to OHCA; a concept referred to as pre-hospital critical care. 11,12 Pre-hospital critical care for OHCA The mechanisms by which outcomes might be improved through the presence of prehospital critical care practitioners include ALS-interventions undertaken more efficiently, supplementation of ALS-protocols with enhanced experience and clinical judgment and an advanced level of post-arrest treatment, including transport to the most appropriate destination hospital. 13 There is little research addressing the concept of pre-hospital critical care in general, and in the context of OHCA specifically.…”

Section: Introductionmentioning

confidence: 99%

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The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

2015

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The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation, 96. pp. 290-295. ISSN 0300-9572 Available from: http://eprints.uwe.ac.uk/29457We recommend you cite the published version. The publisher's URL is: http://dx.doi.org/10.1016/j.resuscitation.2015.08.020Refereed: Yes (no note) Disclaimer UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material. UWE makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited. UWE makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights. UWE accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 1 THE IMPACT OF A PRE-HOSPITAL CRITICAL CARE TEAM ON SURVIVAL FROM OUT-OF- WORD COUNT, REFERENCES, FIGURES AND TABLES Abstract: 233Manuscript: 3045 ABSTRACT AimTo assess the impact of a pre-hospital critical care team (CCT) on survival from out-ofhospital cardiac arrest (OHCA). MethodsWe undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. Results1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p < 0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89 to 2.67, p = 0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. ConclusionPre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies.Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 3

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Section: Discussionmentioning

confidence: 99%

Section: Great Western Air Ambulance (Gwaa) Critical Care Teammentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

2015

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“…Dedicated dispatch of CCPs, who are extensively trained in complex competencies, has been shown to improve outcomes for trauma patients. 55,56 The additional resource of an experienced medic, either attending with a CCP or accessible via telecommunication, enhances the combined level of experience available for care.…”

Section: The Paramedic Practitionermentioning

confidence: 99%

A qualitative study of decision-making and safety in ambulance service transitions

O’Hara

Johnson

Hirst³

et al. 2014

Health Services and Delivery Research

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Background: Decisions made by front-line ambulance staff are often time critical and based on limited information, but wrong decisions in this context could have serious consequences for patients. There has been little research carried out in the ambulance service setting to identify areas of risk associated with decisions about patient care.\ud Aim: The aim of this study was to qualitatively examine potential system-wide influences on decision-making in the ambulance service setting and to identify useful areas for future research and intervention.\ud Methods: We used a multisite, multimethod qualitative approach across three ambulance service trusts. In phase 1 we carried out 16 interviews to contextualise the study and provide discussion points for phase 2. For phase 2, university and ambulance service researchers observed paramedics on 34 shifts and 10 paramedics completed ‘digital diaries’ that reported challenges to decision-making or to patient safety. Six focus groups were held, three with staff (n = 21) and three with service users (n = 23). From observation and diary data we developed a typology of decisions made at the scene. Data from these and other sources were also coded within a human factors framework and then thematically analysed to identify influences on those decisions. In phase 3, workshops were held at each site to allow participants and stakeholders (n = 45) to comment on the study findings. Participants were asked to rank influences on decisions using a ‘paired comparison’ method.\ud Results: Interviews provided the context for further qualitative exploration. Nine types of decision were identified from observations and digital diaries, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. A synthesis of findings from the observations, diaries and staff focus groups revealed seven overarching system influences on decision-making and potential risk factors: meeting increasing demand for emergency care; impacts of performance regime and priorities on service delivery; access to appropriate care options; disproportionate risk aversion; education, training and professional development for crews; communication and feedback to crews; and ambulance service resources. Safety culture issues were also identified. Data from the service user focus groups reflected similar issues to those identified from the staff focus groups. Service user concerns included call handling and communication, triage, patient involvement in decisions, balancing demand, resources, access to care, risk aversion, geographical location and vulnerable patients. Group discussions highlighted a lack of awareness by the public of how best to use emergency and urgent care services. Workshop attendees were satisfied that the findings reflected relevant issues. The two issues ranked highest for warranting attention were staff training and development and access to alternative care.\ud Conclusions: Multiple qualitative methods allowed a range of perspectives to be accessed and validation o...

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“…It can be concluded that the doctor is on duty in two places at once (in the SOR and, if necessary, in emergency medical services). This solution was used in many countries, mainly due to the following aspects: -analyses revealed that a doctor in emergency ambulances is needed in a small number of cases, in relation to the total number of interventions; -the costs of maintaining the "S" teams at the ready were reduced; -it was faster for a doctor to arrive at the emergency site to support the basic teams; -personal staff in hospital wards was increased [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Pacjent w ACS STEMI i lekarz w systemie na telefon — opis przypadku

et al. 2017

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The Emergency Medical Services in Poland was constituted to save human health and life. Regardless of applied system solutions, all countries are guided by this assumption. In Poland, the law, which was enforced in 2007, has developed two types of emergency ambulances: one including the doctor (the "S" team), and one with paramedics only (the "P" team). The "S" team should be sent to all life-threatening conditions, and the "P" team to the remaining conditions. It is noteworthy that in some countries there are only basic teams, and their ability of action and pharmacotherapy is imposed by legal regulations operating in the country. In other systems in Europe, the basic team may rely on the support of a doctor that arrives at the emergency site.In the case described, a patient with myocardial infarction (STEMI, ST-elevation myocardial infarction) with complicated pulmonary edema was initially supplied by the basic team. Due to the serious condition of the patient and the limited ability of action, the doctor was asked to support the team. The reported case presents a solution to abandon the permanent specialist teams that is feasible to apply (not only in Poland), and it suggests other solutions increasing efficiency of activities of the rescue teams.

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Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians

Cited by 45 publications

References 19 publications

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

A qualitative study of decision-making and safety in ambulance service transitions

Pacjent w ACS STEMI i lekarz w systemie na telefon — opis przypadku

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