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.
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.
This research study aims to examine the relationship between inhibitory control performance and PTSD symptom severity in a sample of emergency service personnel, specifically paramedics and firefighters. It is hoped that this will contribute to the wider literature examining whether executive functioning difficulties, and inhibitory control difficulties more specifically, reflect a potential cognitive marker of PTSD. Exclusion criteria include neurological conditions/factors known to affect neurological functioning (e.g., ADHD, Epilepsy, neurological conditions associated with brain/head injuries). Interested participants will be provided with a online link to complete the study. Consenting participants will asked to complete the online versions of self-report questionnaires asking about experiences of traumatic events and PTSD symptoms as well as experiences of symptoms of depression. Participants will then proceed to complete an online version of two computerised inhibitory control tasks (the Go/No-Go and Irrelevant Singleton tasks). The study procedure is expected to take approximately one hour to complete and participants will be compensated with a £25 Amazon Voucher.
Objective: Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care. Design: Systematic mapping review and narrative synthesis. Data sources: Searches were conducted using MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. Eligibility criteria: Quantitative, qualitative, mixed-methods or systematic review research that included a clinical decision support tool for assessing and managing children with head injury. Data extraction and synthesis: We systematically identified all in-hospital clinical decision support tools and extracted from these the clinical criteria used in decision-making. We complemented this with a narrative synthesis. Results: Following de-duplication, 887 articles were identified. After screening titles and abstracts, 710 articles were excluded, leaving 177 full-text articles. Of these, 95 were excluded, yielding 82 studies. A further 14 studies were identified in the literature after cross-checking, totalling 96 analysed studies. 25 relevant in-hospital clinical decision tools were identified, encompassing 67 different clinical criteria, which were grouped into 18 categories. Conclusion: Factors that should be considered for use in a clinical decision tool designed to support paramedics in the assessment and management of children with head injury are: signs of skull fracture; a large, boggy or non-frontal scalp haematoma neurological deficit; Glasgow Coma Score less than 15; prolonged or worsening headache; prolonged loss of consciousness; post-traumatic seizure; amnesia in older children; non-accidental injury; drug or alcohol use; and less than 1 year old. Clinical criteria that require further investigation include mechanism of injury, clotting impairment/anticoagulation, vertigo, length of time of unconsciousness and number of vomits.
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.
This will be an online survery to explore and understand the influences on paramedic prescribers' decision-making when prescribing antibiotics for acute cough in primary care settings in the UK. An online questionnaire will be distributed using Jisc Online Surveys. The questionnaire will be completable in 10-15 minutes. It will gather demographic information such as years experience, region of the UK, practice setting, consultation and home visit duration, access to support and supervision. Quantitative data using close-ended questions (e.g. Likert-scale and multiple choice questions) and open-ended questions to allow for greater insight into clinical, non-clinical, organisational influences on antibiotic prescribing for acute cough and views regarding paramedic role in antibiotic stewardship. Recruitment will take place via social media using Facebook groups (e.g. Prescribing Paramedics UK, Advanced Clinical Practitioner Forum, Paramedics In Primary Care, Primary Care Paramedics). Snowball sampling will be encouraged via professional contacts. Participation will be voluntary, unpaid, and withdrawal will be possible at all stages. Quantitative data will be analysed using descriptive statistics. Thematic analysis will be employed to summarise data from open-ended questions. The study will provide insights into paramedic prescribing behaviour. Findings may inform future training, antibiotic stewardship strategies, and policy developments.
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?
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.
The EPiCC study aims to better understand the challenges and opportunities around equality, diversity, and inclusion (EDI) in prehospital critical care roles—jobs like those held by paramedics and doctors in air ambulance and ambulance services. While more women have entered emergency medical services in recent years, people from minority ethnic groups and other underrepresented backgrounds are still not well represented, especially in high-level critical care positions. This research will collect survey responses from clinicians currently in critical care roles, those aiming for these roles, and those who have tried but not succeeded. The study will explore their experiences—both positive and negative—to identify what helps and what hinders a diverse and inclusive workforce. The goal is to provide clear insights that ambulance services and other employers can use to create fairer and more supportive working environments. By improving diversity and inclusion in these high-stakes medical teams, we hope to support staff wellbeing, improve career access for underrepresented groups, and ultimately deliver better patient care.
Atrial fibrillation and atrial flutter (AF) are associated with an increased risk of stroke and systemic embolism. This risk can be substantially reduced using oral anticoagulant (OAC) medications, but as AF can be asymptomatic, it often goes unnoticed. Ambulance clinicians can therefore sometimes detect AF as an incidental finding during their routine assessment of patients. In the instance of the patient then not being taken to hospital, this information needs to be passed on to the general practitioner (GP) for review and follow up. Currently, individual clinicians contact GPs directly to let them know when AF is identified, which is not always possible and can take time. In partnership with ambulance clinicians and GPs, we have developed a new tool within the existing ambulance electronic patient care record so that a letter can automatically be sent to the GP, with the ECG attached, for patients in whom incidental AF is detected. In the year after this notification process launches we will measure how often it is used, whether the GP record has been updated with the AF diagnosis and if appropriate medication was then prescribed. Data from comparator patients in the year before the intervention was live will also be analysed, as well as those eligible but not exposed to the new notification process.
Paramedic clinical practice has seen significant evolution from the traditional role of transporting patients to an emergency department (ED). An evolving and flexible scope of practice, modernisation and healthcare reform has necessitated the development of a range of referral pathways for paramedics, with the aim of ensuring that service users receive the most appropriate care at point of contact. Ambulance conveyance rates to EDs in Northern Ireland (NI) have only occasionally fallen below 75%. A study examining a Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than those of comparable ambulance services. A similar study found that over 70% of people who experience a fall are not referred to falls prevention services. This study aimed to identify what paramedics perceive the barriers and facilitators to the use of appropriate care pathways (ACPs) in NI are.
This study aims to understand what knowledge paramedics in the United Kingdom have about breastfeeding and their confidence in supporting breastfeeding and breastfed patients.