This study explores how family members experience and perceive bereavement care provided by the ambulance service when a loved one dies in the pre-hospital setting. Bereavement care refers to the support provided to families after the death of a loved one. The study aims to understand what families need during this time and how ambulance services can improve their support. We will invite people who, in the past two years, have lost a family member while receiving care from the ambulance service. This includes cases where the patient died at the scene or shortly after being transported to the hospital. The two-year time frame ensures that experiences reflect current practices, without focusing on care during the COVID-19 pandemic. Participants will be interviewed either in person at a local ambulance service site or online via Microsoft Teams. The interviews will explore family members' experiences and what they felt was helpful or could have been done differently. Each interview will last between 30 and 60 minutes, and all responses will be anonymised to protect participants’ privacy. The results will be analysed to identify themes about what families value and need during this difficult time. This will help the ambulance service improve how it supports grieving families. We will recruit participants through posters in healthcare settings, social media, and partnerships with bereavement charities. Participation is voluntary, and people can withdraw at any point up to 24 hours after the interview. The study aims to highlight family members’ voices to ensure bereavement care is compassionate and meets their needs. Findings will be shared with the ambulance service and published to improve care standards.
When faced with children paramedics (and other healthcare professionals) may have to estimate weight which can be used as a basis for administering drugs. Many estimation techniques rely on the patient’s chronological age however this has been shown to be unreliable (Black et al., 2002; Marlow et al., 2011; Charlton, Capsey and Moat, 2020), and in some cases a patient’s age may be unknown. Other techniques include parental estimation (Krieser et al., 2007) and measuring systems based on height and size (e.g. Braselow tape). Anecdotally paramedics may use a child’s clothing size to estimate age, and thus weight, when this is unknown. It is expected that the findings of this study will be used to improve the safe and effective treatment of children treated by paramedics by informing methods to estimate weight. This study will use a combination of face-to-face and online questionnaires to compare parental estimation, age-based formulae, and clothing size based formulae to establish their accuracy. The reference standard will be that 70% of estimations are within 10% of the actual weight, and 95% are within 20% (Wells et al., 2017).
Ambulance clinicians often encounter challenging situations involving patient deaths and serious accidents, requiring them to provide bereavement care to affected families. However, research indicates that many ambulance clinicians feel unprepared for this role, citing a lack of formal training in breaking bad news (BBN) and managing bereavement. This can lead to significant emotional strain, impacting their mental health, professional performance, and personal lives. Existing coping strategies and training protocols, such as SPIKES and GRIE_VING, have shown some promise but are not widely known or implemented in pre-hospital care. This study aims to address these challenges by exploring the perspectives and practices of ambulance clinicians in the North East Ambulance Service (NEAS) regarding bereavement care. The research seeks to understand how clinicians perceive their role in supporting families and to identify potential improvements in bereavement care delivery, both for the families and for the clinicians themselves. The study employs a mixed-methods approach. It will begin with a quantitative survey of NEAS clinicians to gather insights into their current bereavement care practices. This will be followed by focus group discussions to explore their experiences in greater depth. Participants will include frontline NEAS ambulance clinicians who have encountered bereavement care situations in the past five years. Findings from this research will provide valuable insights into the realities of bereavement care in pre-hospital settings and help to inform evidence-based strategies for training and support. Ultimately, the goal is to enhance bereavement care for families and better equip ambulance clinicians for this critical aspect of their role.
West Midlands Ambulance Service crews are taking blood and saliva samples at first point of contact with suspected stroke patients. These are then tested in University of Birmingham facilities to see if we can identify stroke biomarkers in these ultra-early samples.
Background and rationales: Recognising that someone has deteriorating health can be a trigger for a change in their care plan, and potentially for advance care planning and introducing palliative care. While there are tools that can provide an objective measure of someone’s health status (for example scales designed to measure functional status), changes in a patient’s general appearance may be the first sign that their health is deteriorating. For example, people with white skin may look ‘grey’ or ‘sallow’ as their illness advances. For people with advanced and life-limiting illness, these subtle cues can be a trigger for health care professionals to discuss goals of care, the risks and benefits of further treatment, or to refer to specialist palliative care teams. We know that people from minoritised ethnic groups are less likely to access specialist palliative care and more likely to have frequent Emergency Department visits towards the end of life, though the reasons for this are not clear. We also know that identification of a diverse range of skin signs (such as rashes, pressure damage) can be challenging among people of colour. If health professionals are less able to identify deteriorating health among people of colour, this could lead to higher rates of Emergency Department attendance near the end of life, or delay in referral to palliative care. Whether and how skin colour influences how health professionals make judgements about people’s health in advancing illness is unclear, but is a potential source of racial bias. Research Questions: 1/ What are the skin changes that are used by health and care professionals as an indication that someone with advanced illnesses is deteriorating? 2/ How confident and competent are health and care professionals in identifying these skin changes in people of colour? Method: Two workstreams will occur in parallel. WS1: A rapid review will be undertaken to identify published evidence on (i) changes in skin and appearance that may indicate that someone with advanced illness is deteriorating, (ii) whether these changes are as readily identifiable among people of colour, and (iii) health and care professionals’ confidence in identifying these changes. Using guidance on literature searching for rapid reviews from the Cochrane Rapid Reviews Methods Group, we will perform focused searches on MEDLINE and Embase databases via OVID and utilise citation searching of known relevant references to supplement. Based on scoping searches, we anticipate that the rapid review will identify relatively little evidence. Therefore, in WS2 we will draw on health and care professionals’ experiential knowledge. WS2 Expert consultations will be held with health and care professionals to explore their experience in using skin and appearance changes to identify deterioration in health for people with advanced illnesses. At least two expert consultations will be held online, each lasting 90-120 minutes, and each including 6-10 health and care professionals who regularly care for people with advanced illness. Professional groups will include GPs, geriatricians, community nurses, care home professionals and specialist palliative care professionals. One expert consultation will be for professionals who practice in the UK, selecting those who practice in areas with high levels of ethnic diversity. Another will be for professionals who practice outside the UK in countries where the majority of the population are people of colour. A facilitated conversation will explore professionals’ experience in identifying deteriorating health in people who have advanced illness, their confidence to identify these changes, and whether there are differences for people of colour. Findings from the rapid review will be used to guide questions. PPI: We will convene a group of patients and public members who represent diverse ethnicities to guide the research, meeting with them regularly to discuss the research questions and emerging findings. As part of WS2 we will invite PPI members to observe (with their cameras off) the expert consultations and feed back their reflections about the discussions to the research team, to guide interpretation. In the expert consultations, we will aim to explore: 1/ health and the professionals’ experience in identifying changes in skin that may indicate that someone with an advanced illness is deteriorating; 2/ whether these changes are as readily identifiable among people of colour; and 3/ health and care professionals’ confidence and competence in identifying these changes among people of all skin tones Eligibility of taking part in the online expert consultation includes all of the following (for UK-based professionals): 1/ Health and care professionals who regularly care for adults with advanced illnesses 2/ GPs, geriatricians, community nurses, care home professionals, paramedics, or specialist palliative care professionals 3/ practice in the UK and in areas with high levels of ethnic diversity The online expert consultation meeting will last 90 minutes and involve 6-10 health and care professionals who regularly care for adults with advanced illnesses. We are planning to hold the consultation for health and care professionals based in the UK on Thursday, 13 February 2025, 11.00-12.30 (GMT) on Microsoft Teams.
To adequately prepare graduates for the dynamic demands of paramedic practice, adopting a contemporary educational approach is essential. This involves collaborating to identify crucial competencies through input from industry stakeholders, experienced practitioners, and discipline-specific experts. Accreditation assumes a central role within this framework, serving as a cornerstone to ensure that paramedicine curricula align with paramedics' diverse and evolving professional roles. Methods A narrative review of the literature and a directed search of grey literature were performed to identify specific developments in paramedicine competencies and scope of practice and mapped to the professional capabilities published by the Paramedicine Board of Australia. In determining a competency map and accreditation’s role in a competency framework specific to current and evolving paramedic practice, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents, countries and other professions. Results The review process identified 278 themes that were further allocated to 22 major analytical groupings. These groupings could further be mapped to previously reported cognitive, technical, integrative, context, relationship, affective/moral competencies and habits of mind. At the same time, the highest-rated groupings were key competencies of intellectual skills, safety, accountability, clinical decision-making, professionalism, communications, team-based approach and situational awareness. Two groups were represented in the literature but not in the professional capabilities, namely Health and Social continuum and self-directed practice. Conclusions This review highlights the importance of measuring and validating the professional capabilities of Paramedicine Practitioners. The study explores various metrics and competency frameworks used to assess competency, comparing them against national accreditation schemes' professional capability standards. The findings suggest that accreditation frameworks play a crucial role in improving the quality of paramedicine practice, encompassing intellectual skills, safety, accountability, clinical decision-making, professionalism, communication, teamwork, and situational awareness.
It is a legal requirement for NHS ambulance trusts to collect patient ethnicity data, and improvements are needed as current adherence is poor. This study aims to interview frontline NHS ambulance staff in England, like paramedics or technicians, who complete ambulance call out documentation to explore the perceived barriers in this specific staff group to collecting this information. It is important to understand these barriers because the lack of patient ethnicity data in ambulance call-out documentation makes it difficult to monitor if health inequalities due to ethnicity exist. Health inequalities are unfair and avoidable difference in health, like when it was reported during the covid19 pandemic that black, Asian and minority ethnic groups were at higher risk of infection, severe symptoms, and death. This link was only found due to routine collection of patient ethnicity data. This study will look for volunteers across up to 10 NHS ambulance services in England who work in frontline roles, specifically those who have face-to-face contact with patients calling 999 and complete ambulance call-out documentation as a result. The study will aim to recruit 20 participants between February and July 2025. Participants will be asked to attend a 60- minute interview online using MS Teams.
The last 4 years has seen England’s ambulance services sustain unprecedented pressure from the operational demand generated by the pandemic. Operational demand remains high, with system failures, low morale, toxic cultures and hazardous environments causing significant wellbeing, and retention problems. Ambulance staff are more likely to develop mental health conditions such as PTSD than any other emergency service, with many ambulance staff also suffering from assaults, and burnout. If ambulance service senior leaders were better connected to the needs of their staff, however, bespoke leadership models/qualities/skills could be introduced to counteract some of the challenges identified. At the time of writing, no UK research that explores what frontline ambulance service staff need from senior leaders by way of support could be found. This, therefore, is core the focus of our investigations: to understand perceptions and experiences of leadership among these staff, and the type of leaders they need to support them during challenging times. Semi-structured interviews (online) were utilised to capture data which allows the research question to be answered.
This research seeks to understand the links between the culture in ambulance trusts, management decision making and the support provided to Disabled staff. The study will look at the understanding of the term disability, how it is viewed and what is involved in the decision-making process when a request for support is made.
This study will explore how real-time feedback affects ambulance clinicians’ ability to perform ventilations during a simulated cardiac arrest scenario over six months. Ventilations, typically given via a bag-valve-mask (BVM), are a basic life support skill performed by paramedics in emergency situations, but evidence suggests that many clinicians struggle to deliver ventilations according to guidelines. Feedback during training can help improve these skills, but without regular updates or refresher training, the skills may deteriorate over time. The study will involve participants from a single ambulance service, randomly assigned to three groups. All of these groups will participate in a simulation using a resuscitation manikin. The first group will receive feedback on their ventilations at every session, the second will receive feedback only at the first session, and the third will receive no feedback and act as a control. Ventilation rates and volumes will be measured using a Zoll X-series monitor, which provides real-time feedback. The main aim of the study is to compare the quality of ventilations at the six-month mark between the three groups. A secondary focus will be tracking any changes in ventilation quality across the six months, to identify potential skill improvements or fade.
This qualitative study is exploring stakeholder perspectives with experience of paramedics working in primary care, on the education and training required to work effectively as a paramedic in primary care settings, establishing whether paramedics have the appropriate education, training, and skills and whether this model is sustainable.
A multicentre, explanatory sequential mixed methods study. Phase 1 consists of an online survey and phase 2 involves semi-structured interviews with key stakeholders from UK NHS ambulance services in order to explore the perceptions and views of ambulance service staff on research culture and capacity building.