Whilst research on MECC implementation and evaluation is fairly established in other areas of healthcare, there is limited existing evidence specific to the ambulance service setting, despite paramedics being in a unique position where they engage with a wide range of the population, some of whom may not routinely be seen by other healthcare professionals. Without clear evidence on how MECC has been implemented and how staff utilise this framework on a day-to-day basis, it is hard to evaluate or further improve its use. The study will be conducted in at least three UK NHS Ambulance Trusts, focus groups will seek to explore the content of MECC conversations discussed by participants, as well as the perceived barriers and facilitators of paramedics having MECC conversations.
People with adrenal insufficiency cannot produce enough of the hormone cortisol, which is vital for coping with physical stress, illness, or injury. Without enough cortisol, the body cannot respond properly, which can lead to a life-threatening complication called an adrenal crisis. Each year, around 6–8% of people with adrenal insufficiency experience an adrenal crisis, most often triggered by infection, vomiting, or another illness. Symptoms can include severe weakness, vomiting, confusion, dangerously low blood pressure and collapse. Immediate treatment with an emergency hydrocortisone injection and fluids is vital to prevent avoidable hospital admissions and deaths. Around one in 200 patients who experience an adrenal crisis may die, despite its preventable nature. However, despite clear clinical guidelines and the availability of emergency tools and protocols, delays in recognising and managing adrenal crises are still common in emergency care settings. With fast recognition and proper treatment, most adrenal crises can be effectively managed and prevented from becoming life-threatening. This research study aims to understand how adrenal crises are currently managed by emergency services, both before arrival at the hospital by ambulance staff and in the emergency department. We also want to learn about the experiences of people living with adrenal insufficiency who have recently had an adrenal crisis. Understanding how well the current system works (and where it does not) can help identify ways to improve care and reduce preventable harm. The study focuses on two population groups: · Group A: Healthcare professionals who work in ambulance services, A&E, or urgent care settings. · Group B: Adults with adrenal insufficiency who have had an adrenal crisis in the past 12 months. In both groups, participants will first complete an online survey. This will include questions about their experiences, challenges, and what helped or got in the way of timely treatment. Participants will then have the option to take part in a follow-up interview by video call to explore these issues in more depth. For example, patients will be asked how they recognised their symptoms, whether they had an emergency injection kit, and how long it took to get treated. Healthcare professionals will be asked about how confident they feel in recognising and treating an adrenal crisis, and what support or training they have received. The information collected will be analysed using a framework called the COM-B model, which helps identify what people need in order to carry out certain behaviours, in this case, recognising and managing adrenal crisis. It considers three key areas: Capability (knowledge and skills), Opportunity (resources and system support), and Motivation (confidence and beliefs). The findings from patients and professionals will then be compared and brought together to create a Systems Model, a step-by-step map of how adrenal crisis care is currently delivered, and where breakdowns or delays occur. This model will guide the development and co-design of future interventions (solutions). The goal is to design a set of practical, evidence-based interventions, such as improved training, new tools, or changes to care pathways, that can be tested in future research. By improving the way adrenal crisis is managed in emergency care, we hope to reduce avoidable harm, improve patient safety, and help healthcare professionals feel more confident in providing life-saving treatment when it is urgently needed.
Paramedicine is undergoing a rapid change on a steep trajectory in a short time. Indeed, there is still a widely held view that paramedicine and ambulance services are two of the same thing, but the reality is starkly different. Whilst much attention is focused on the front-line of paramedicine through the lens of emergency ambulance services, there is a paucity of any real insight into the upper echelons in the corridors of power and influence of and within the profession and associated linked ecologies. Professionalisation has been at the forefront of the profession's agenda for many years - developing organically, with no apparent clear or directed strategy. Indeed, whilst paramedicine demonstrates many of the classic hallmarks of a profession as seen in classic sociology of professions literature (McCann, 2022, Leicht and Fennell, 2001, Muzio et al., 2019), this development has not been in congruence with all parts of the sum. Paramedics in the UK are represented by, and regulated by UK-wide bodies – but work in increasingly stratified areas: 3 national, ten regional ambulance services in four public healthcare bodies reporting to four different governments – let alone outside the ambulance sector. With the profession no longer limited to its historical organisational home how can, and more importantly, does the profession have a strategy (Hambrick and Fredrickson, 2005) and who “owns” it? To date, research into the paramedic profession has almost exclusively focused on the operational frontline clinicians (McCann, 2022). This study aims to ask the following key research questions, at a senior/strategic level. Given the focus on strategic and system level thinking in the wider NHS at this time, this work is critical to add to this area of importance. • How is the paramedic profession pursuing a professionalisation strategy? • What are the roles and implications for different constituents in this process? • How can we understand the boundaries of the profession's claimed “scope/territory”? • How can we evaluate the possible success/failures of the strategy?
This project is in partial fulfilment of a PhD, which is developing a care pathway for dislocation after hip replacement. The first part of the project was a national survey that mapped the existing care provisions for patients who experience dislocation after hip replacement to understand the current care practice and identify possible contexts for intervention development. The second part of the project is a qualitative interview exploring the care experiences for dislocation after hip replacement. To inform the development of the care pathway, we want to understand the experience of clinicians, including Paramedics and Ambulance staff, in delivering care for dislocation after hip replacement. The third and last part of the project would be to co-design (with patients and clinicians) the care pathway for dislocation after hip replacement.
The study aims to obtain a comprehensive view of the EDI landscape within prehospital critical care by exploring a diverse range of clinician perspectives. This includes those currently working within critical care roles and those from the broader prehospital workforce who may aspire to or have previously sought critical care positions. By capturing positive and challenging experiences in accessing and progressing within critical care roles, this study seeks to identify actionable insights that will benefit all levels of the prehospital clinical workforce. The study is in the form of an anonymous online questionnaire. It is a collaboration between AAKSS and SECamb.
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.
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.
Naloxone is widely recommended for opioid overdose in humans, and is in many jurisdictions, including in the United States of America, distributed to police officers, social workers and laypeople for administration in such circumstances. There is a paucity of evidence regarding its use in cardiac arrest induced by opioid overdose, but such use is nonetheless generally recommended. Rat models, however, have been known for some time to show naloxone administration in asphyxia-induced cardiac arrest without opioid use having comparable benefit to the administration of epinephrine, and some recent evidence has suggested that naloxone in cardiac arrest may also be of benefit in humans, even where the arrest was not thought to be opioid-induced. This study will employ a binary logistic regression model to investigate whether naloxone administration impacts rates of sustained ROSC and survival to hospital discharge, both in overdoses and in non-overdose arrests. It is a retrospective analysis of the Cardiac Arrest Registry to Enhance Survival (CARES) dataset, which is a national-level cardiac arrest registry in the United States of America with a catchment of over 186 million people and which has enrolled more than 1.3 million patients.
This is a sequential mixed methods, pre and post questionnaire study. Student paramedics from UK based universities will be asked to complete a quantitative questionnaire getting them to self rate their levels of reflection and well-being. They will then be given a digital tool (WRAPT tool) which is an online model of reflection to use whilst on their ambulance placement for a minimum of 4 weeks. After using this tool for a minimum of 4 times, for a minimum of 4 weeks they will then be given the same questionnaire getting them to self rate their levels of reflection and well-being and to rate the usability of the WRAPT tool. This will evaluate if there has been a change in the participants well-being, self insight, and self-reflective abilities after using the WRAPT tool. Based on the results of the questionnaires an interview guide will be created. A sample of participants who completed both questionnaires will be invited to discuss the strengths and weaknesses of the tool, as well as their overall experience.
This study aims to understand what knowledge paramedics in the United Kingdom have about breastfeeding and their confidence in supporting breastfeeding and breastfed patients.
The demand for mental health support in England has risen sharply in recent years, exceeding the capacity of available services. Approximately 1.2 million people are currently on NHS community mental health waiting lists, placing increased strain on paramedics, who now spend an estimated 1.8 million hours annually responding to mental health-related calls. As frontline responders, paramedics play a critical role in providing urgent care to individuals experiencing mental health difficulties. However, existing research highlights that paramedics tend to feel frustration, uncertainty, and lack of confidence when managing patients with mental health presentations. Despite this, there is currently no standardised mental health education or training requirement for paramedics in England, and limited research has explored the specific knowledge gaps that hinder their ability to provide effective care. This study aims to identify and assess the knowledge gaps and educational needs of paramedics regarding mental health care. Findings will inform the development of targeted educational initiatives, equipping paramedics with the necessary skills to improve patient outcomes and bridge gaps in pre-hospital mental health care.
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.