Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation.

Background: Mechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA).

Objective: Evaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA.

Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial.

Background: Mechanical chest compression devices have the potential to help maintain high-quality cardiopulmonary resuscitation (CPR), but despite their increasing use, little evidence exists for their effectiveness. We aimed to study whether the introduction of LUCAS-2 mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest.

Methods: The pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PARAMEDIC) trial was a pragmatic, cluster-randomised open-label trial including adults with non-traumatic, out-of-hospital cardiac arrest from four UK Ambulance Services (West Midlands, North East England, Wales, South Central).

Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project.

Objective: To describe patterns of prehospital ECG (PHECG) use and determine its association with processes and outcomes of care in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI.

Methods: Population-based linked cohort study of a national myocardial infarction registry.

Results: 288 990 patients were admitted to hospitals via emergency medical services (EMS) between 1 January 2005 and 31 December 2009.

Protocol C: a nonguidelines-compliant approach to improve survival of patients with out-of-hospital cardiac arrest.

Purpose Of Review: To describe a resuscitation protocol for out-of-hospital cardiac arrest designed for healthcare professionals that demands more from rescuers than does conventional cardiopulmonary resuscitation. It was introduced with the aim of improving survival that has remained disappointingly poor worldwide.

Recent Findings: Survival to hospital discharge, that could be measured accurately in one city, improved appreciably with the use of the novel protocol.

Achy breaky makey wakey heart? A randomised crossover trial of musical prompts.

Objective: Compared with no music (NM), does listening to 'Achy breaky heart' (ABH) or 'Disco science' (DS) increase the proportion of prehospital professionals delivering chest compressions at 2010 guideline-compliant rates of 100-120 bpm and 50-60 mm depths?

Methods: A randomised crossover trial recruiting at an Australian ambulance conference. Volunteers performed three 1-min sequences of continuous chest compressions on a manikin accompanied by NM, repeated choruses of ABH and DS, prerandomised for order.

Results: 37 of 74 participants were men; median age 37 years; 61% were paramedics, 20% students and 19% other health professionals.

Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals.

Introduction: International guidelines for basic life support and defibrillation are identical for lay people and healthcare professionals. In 2002, a small meeting hosted by the Resuscitation Council (UK) debated recent advances in resuscitation science, along with the possibility of more demanding procedures for treating out of hospital cardiac arrest (OHCA) that could take advantage of the expertise available with professional use. The resulting algorithm known as Protocol C could not be tested in a randomized trial for reasons relating to consent, but was introduced by one ambulance service as an observational study.

Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC) trial protocol.

Background: Survival after out-of-hospital cardiac arrest is closely linked to the quality of CPR, but in real life, resuscitation during prehospital care and ambulance transport is often suboptimal. Mechanical chest compression devices deliver consistent chest compressions, are not prone to fatigue and could potentially overcome some of the limitations of manual chest compression. However, there is no high-quality evidence that they improve clinical outcomes, or that they are cost effective.

The reliability of vital signs in estimating pain severity among adult patients treated by paramedics.

Background: The aim of this study was to examine the strength of correlation between initial pain severity score and systolic blood pressure, heart rate and respiratory rates among adults reporting pain in the prehospital setting as a means of validating the presence and severity of pain.

Methods: A retrospective cohort study was conducted including all adults with a Glasgow Coma Score >12 assessed by paramedics in a metropolitan area over a 7 day period in 2005. Pain was self-scored by patients using a 0-10 numeric rating scale (NRS).

Does the introduction of a COPD pro-forma improve the standards of care delivered by junior doctors in the emergency department.

Aim: To determine if pro-forma based management improves standards of care delivered by junior doctors in chronic obstructive pulmonary disease (COPD) patients in the Emergency Department (ED).

Introduction: National COPD audits have found large variations in ED standards of care compared to guidelines. They concluded that the publication of guidelines itself does not translate to an improvement in care.

Skill acquisition by health care workers in the Resuscitation Council (UK) 2005 Guidelines for Adult Basic Life Support.

This prospective study compared pre- and post-class performance in basic life support (BLS) on a recording manikin in a convenience sample of 34 health care workers undertaking a two-hour class provided by a hospital resuscitation department teaching the 2005 Resuscitation Council (UK) guidelines. On completion of training there were significant improvements in the proportion of subjects correctly performing a safe approach (14/34 vs. 25/33, 95%CI +11 to +55%, p=0.

Paramedic practitioners and emergency admissions.

Evidence suggests a positive effect, but future programmes need rigorous assessment before being expanded

'Should I stay or should I go?' Deciding whether to go to hospital after a 999 call.

Objective: In most UK ambulance services, crews attending someone who has phoned the emergency services on '999' will take the patient to hospital, unless the patient makes the decision to stay at home (or wherever they happen to be when the ambulance arrives). Safety concerns have been raised about non-conveyance decisions. We undertook a study of one UK Ambulance Service to examine ambulance crew members' views on how decision-making about non-conveyance works in practice in relation to non-urgent calls.

Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial.

Aim: To determine the optimal refresher training interval for lay volunteer responders in the English National Defibrillator Programme who had previously undertaken a conventional 4-h initial class and a first refresher class at 6 months.

Methods: Subjects were randomised to receive either two additional refresher classes at intervals of 7 and 12 months or one additional refresher class after 12 months.

Results: Greater skill loss had occurred when the second refresher class was undertaken at 12 compared with 7 months.

Associations between organizational and incident factors and emotional distress in emergency ambulance personnel.

Objectives: This study examined the prevalence and correlates of post-traumatic stress disorder (PTSD), anxiety and depression among emergency ambulance personnel.

Design And Method: A questionnaire and reminder were sent anonymously to 1029 emergency ambulance personnel in a large ambulance service.

Results: Among the 617 respondents, levels of PTSD symptoms did not differ according to grade, but men had a higher prevalence rate than women.

Outcome of asymptomatic electric shock victims requesting an emergency ambulance.

Objective: To determine whether patients suffering from electric shock without significant symptoms at the point of an emergency call could be appropriately assigned a nonemergency ambulance response using the Medical Priority Dispatch System (MPDS).

Methods: Welsh Ambulance Service dispatch records were searched to identify patients allocated the MPDS code of 15C01 (electric shock without priority symptoms) over a 30-month period. Ambulance and hospital records were also reviewed.

Trials of teaching methods in basic life support (4): comparison of simulated CPR performance at unannounced home testing after conventional or staged training.

This study compares the retention of basic life support (BLS) skills after 6 and 12 months by lay persons trained either in a conventional manner, or using a staged approach. Three classes, each of 2h, were offered to volunteers over a period of 4 months. For the conventional group, the second and third classes consisted of review of skills.

Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study.

This prospective study evaluated the acquisition and retention of skills in cardio-pulmonary resuscitation (CPR) and the use of the automated external defibrillator (AED) by lay volunteers involved in the Department of Health, England National Defibrillator Programme. One hundred and twelve trainees were tested immediately before and after and initial 4-h class; 76 were similarly reassessed at refresher training 6 months later. A standardised test scenario that required assessment of the casualty, CPR and the use of on AED was evaluated using recording manikin data and video recordings.

Reliability of the Cardiff Test of basic life support and automated external defibrillation version 3.1.

The introduction of the European Resuscitation Guidelines (2000) for cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) prompted the development of an up-to-date and reliable method of assessing the quality of performance of CPR in combination with the use of an AED. The Cardiff Test of basic life support (BLS) and AED version 3.1 was developed to meet this need and uses standardised checklists to retrospectively evaluate performance from analyses of video recordings and data drawn from a laptop computer attached to a training manikin.