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More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face. [ABSTRACT FROM AUTHOR]

Aim: The management of hypothermic casualties is a challenge faced by all prehospital and search and rescue (SAR) teams. It is not known how the practice of these diverse teams compare. The aim of this study was to review prehospital hypothermia management across a wide range of SAR providers in the UK.Methods: A survey of ground ambulances (GAs), air ambulances (AAs), mountain rescue teams (MRTs, including Ministry of Defence), lowland rescue teams (LRTs), cave rescue teams (CRTs), and lifeboats and lifeguard organisations (LLOs) across the UK was conducted between May and November 2017. In total, 189 teams were contacted. Questions investigated packaging methods, temperature measurement and protocols for managing hypothermic casualties.Results: Response rate was 59%, comprising 112 teams from a wide range of organisations. Heavyweight (>3 kg) casualty bags were used by all CRTs, 81% of MRTs, 29% of LRTs, 18% of AAs and 8% of LLOs. Specially designed lightweight (<0.5 kg) blankets or wraps were used by 93% of LRTs, 85% of LLOs, 82% of GAs, 71% of AAs and 50% of MRTs. Bubble wrap was used mainly by AAs, with 35% of AAs reporting its use. Overall, 94% of packaging methods incorporated both insulating and vapour-tight layers. Active warming by heated pads or blankets was used by 65% of AAs, 60% of CRTs, 54% of MRTs, 29% of LRTs and 9% of GAs, with no LLO use. Temperature measurement was reported by all AAs and GAs, 93% of LRTs, 80% of CRTs, 75% of MRTs and 31% of LLOs. The favoured anatomical site for temperature measurement was tympanic. Protocols for packaging hypothermic casualties were reported by 73% of services.Conclusions: This survey describes current practice in prehospital hypothermia management, comparing the various methods used by different teams, and provides a basis to direct further education and research. [ABSTRACT FROM AUTHOR]

Introduction: Public access defibrillation doubles the chances of neurologically intact survival following out-of-hospital cardiac arrest (OHCA). Although there are increasing numbers of defibrillators (automated external defibrillator (AEDs)) available in the community, they are used infrequently, despite often being available. We aimed to match OHCAs with known AED locations in order to understand AED availability, the effects of reduced AED availability at night and the operational radius at which they can be effectively retrieved.Methods: All emergency calls to South Central Ambulance Service from April 2014 to April 2016 were screened to identify cardiac arrests. Each was mapped to the nearest AED, according to the time of day. Mapping software was used to calculate the actual walking distance for a bystander between each OHCA and respective AED, when travelling at a brisk walking speed (4 mph).Results: 4012 cardiac arrests were identified and mapped to one of 2076 AEDs. All AEDs were available during daytime hours, but only 713 at night (34.3%). 5.91% of cardiac arrests were within a retrieval (walking) radius of 100 m during the day, falling to 1.59% out-of-hours. Distances to rural AEDs were greater than in urban areas (P<0.0001). An AED could potentially have been retrieved prior to actual ambulance arrival in 25.3% cases.Conclusion: Existing AEDs are underused; 36.4% of OHCAs are located within 500 m of an AED. Although more AEDs will improve availability, greater use can be made of existing AEDs, particularly by ensuring they are all available on a 24/7 basis. [ABSTRACT FROM AUTHOR]

Objectives There is considerable interest in reducing the cost of clinical trials. Linkage of trial data to administrative datasets and disease-specific registries may improve trial efficiency, but it has not been reported in resuscitation trials conducted in the UK. To assess the feasibility of using national administrative and clinical datasets to follow up patients transported to hospital following attempted resuscitation in a cluster randomised trial of a mechanical chest compression device in out-of-hospital cardiac arrest. Methods Hospital data on trial participants were requested from Hospital Episode Statistics (HES), the Intensive Care National Audit and Research Centre, and Myocardial Ischaemia National Audit Project and National Audit of Percutaneous Coronary Interventions, using unique patient identifiers. Linked data were received between June 2014 and June 2015. Results Of 4471 patients randomised in the pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PARAMEDIC) trial, 2398 (53.6%) were not known to be deceased at emergency department arrival and were eligible for linkage. We achieved an overall match rate of 86.7% in the combined HES accident and emergency, inpatient and critical care dataset, with variable match rates (4.2%-80.4%) in individual datasets. Patient demographics, cardiac arrest-related characteristics and major outcomes were predominantly similar between HES matched and unmatched groups, in the linkage apart from location, response time and return of spontaneous circulation (ROSC) at handover. Conclusions This study shows that it is feasible to track patients from the prehospital setting through to hospital admission using routinely available administrative datasets with a moderate to high degree of success. This approach has the potential to complement the trial data with the demographic and clinical management information about the studied cohort, as well as to improve the efficiency and reduce the costs of follow-up in cardiac arrest trials. Clinical trial registration ISRCTN08233942; Post-results. [ABSTRACT FROM AUTHOR]

Background: UK ambulance services are called to 30 000 cardiac arrests (CAs) annually where resuscitation is attempted. Correct identification by the ambulance service trebles survival by facilitating bystander-cardiopulmonary resuscitation (CPR) and immediate ambulance dispatch. Identification of CA by telephone is challenging and involves algorithms to identify key features. 'NHS Pathways' is now used for triage by six of 12 UK ambulance services, covering a population of 20 million. With the significant improvements in survival when CA is accurately identified, it is vital that 'NHS Pathways' is able to identify CA correctly.Methods: All '999' emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by NHS Pathways v9.04 were identified. All actual or presumed CAs identified by the emergency call taker were cross-referenced with the ambulance crew's Patient Report Form to identify all confirmed CAs.Results: A total of 469 400 emergency (999) calls were received by SCAS. Of the 3119 CA identified by ambulance crew, 753 were not initially classified as CA by NHS Pathways (24.1%). Overall, sensitivity=0.759 (95% CI 0.743 to 0.773); specificity=0.986 (95% CI 0.9858 to 0.98647); and positive predictive value=26.80% (95% CI 25.88 to 27.73%).Conclusions: NHS Pathways accurately identifies 75.9% of adult CAs. The remainder represents approximately 7500 treatable CAs in the UK annually where the diagnosis is missed, with significant implications for patient outcome. Further work is required to improve this first link in the chain of survival. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need to develop prehospital research capability in order to improve the care of patients presenting to emergency medical services (EMS). The Prehospital Randomised Assessment of a Mechanical compression Device In Cardiac arrest trial, a pragmatic cluster randomised trial evaluating the LUCAS-2 device, represents the largest randomised controlled trial conducted by UK ambulance services to date. The aim of this study was to identify and analyse factors that may influence paramedic attitudes to, and participation in, clinical trials.Methods: Personal and organisational experience from this trial was assessed by feedback from a workshop attended by collaborators from participating EMS and a survey of EMS personnel participating in the trial. A work systems model was used to explain the impact of five interwoven themes-person, organisation, tasks, tools & technology and environment-on trial conduct including gathering of high-quality data.Results: The challenge of training a geographically diverse EMS workforce required development of multiple educational solutions. In order to operationalise the trial protocol, internal organisational relationships were perceived as essential. Staff perceptions of the normalisation of participation and ownership of the trial influenced protocol compliance rates. Undertaking research was considered less burdensome when additional tasks were minimised and more difficult when equipment was unavailable. The prehospital environment presents practical challenges for undertaking clinical trials, but our experience suggests these are not insurmountable and should not preclude conducting high-quality research in this setting.Conclusions: Application of a human factors model to the implementation of a clinical trial protocol has improved understanding of the work system, which can inform the future conduct of clinical trials and foster a research culture within UK ambulance services.Trial Registration Number: ISRCTN08233942. [ABSTRACT FROM AUTHOR]

Introduction Growing numbers of public access defibrillators aim to improve the effectiveness of bystander cardiopulmonary resuscitation prior to ambulance arrival. In the UK, however, public access defibrillators are only deployed successfully in 1.7% of out-of-hospital cardiac arrests. We aimed to understand whether this was due to a lack of devices, lack of awareness of their location or a reflection of lack of public knowledge and confidence to use a defibrillator. Methods Face-to-face semistructured open quantitative questionnaire delivered in a busy urban shopping centre, to identify public knowledge relating to public access defibrillation. Results 1004 members of the public aged 9-90 years completed the survey. 61.1% had been first aid trained to a basic life support level. 69.3% claimed to know what an automatic external defibrillator was and 26.1% reported knowing how to use one. Only 5.1% knew where or how to find their nearest public access defibrillator. Only 3.3% of people would attempt to locate a defibrillator in a cardiac arrest situation, and even fewer (2.1%) would actually retrieve and use the device. Conclusions These findings suggest that a lack of public knowledge, confidence in using a defibrillator and the inability to locate a nearby device may be more important than a lack of defibrillators themselves. Underused public access defibrillation is a missed opportunity to save lives, and improving this link in the chain of survival may require these issues to be addressed ahead of investing more funds in actual defibrillator installation. [ABSTRACT FROM AUTHOR]

Introduction: Actively warming hypothermic patients or preventing hypothermia is critical in optimising outcomes in patients with traumatic injuries. Our aim was to investigate the effect of ambient oxygen concentration on the rate and change in temperature of the TechTrade Ready-Heat II exothermic (oxygen-activated) warming blanket, to evaluate safety and ascertain the risk of thermal injury.Methods: A mannequin covered with an exothermic blanket was placed in a sealed oxygen tent. An ambulance blanket was placed between the TechTrade Ready-Heat II exothermic blanket and the mannequin. Two temperature probes were placed directly on the surface of the mannequin; one on the torso away from the heating packs and the other directly beneath the exothermic heating pack. The mannequin was exposed to increasing oxygen concentrations at 10% increments, starting at 21%. The experiment was conducted nine times, each time using a new blanket. Maximum temperature of the mannequin 'skin' and rate of rise were recorded from both temperature sensors.Results: In room air (21% oxygen), the mannequin surface reached 52°C after 60 min, matching manufacturer specifications. At 30% oxygen concentration, the temperature directly beneath the exothermic heating pack exceeded the 65°C threshold at which rapid thermal burns occur, reaching 72.5°C, with minimal change in overall torso temperature.Conclusion: The supplemental use of oxygen in patients with traumatic injuries that increases ambient oxygen levels in the presence of exothermic warming devices may represent a significant risk to the patient. We suggest that prehospital care providers remain highly vigilant of heat when using high-flow oxygen and the subsequent fire risk, while manufacturers of exothermic blankets should consider ways to improve safety. [ABSTRACT FROM AUTHOR]

Introduction Public access defibrillation (PAD) prior to ambulance arrival is a key determinant of survival from out-of-hospital (OOH) cardiac arrest. Implementation of PAD has been underway in the UK for the past 12 years, and its importance in strengthening the chain of survival has been recognised in the government's recent 'Cardiovascular Disease Outcomes Strategy'. The extent of use of PAD in OOH cardiac arrests in the UK is unknown. We surveyed all OOH cardiac arrests in Hampshire over a 12-month period to ascertain the availability and effective use of PAD. Methods A retrospective review of all patients with OOH cardiac arrest attended by South Central Ambulance Service (SCAS) in Hampshire during a 1-year period (1 September 2011 to 31 August 2012) was undertaken. Emergency calls were reviewed to establish the known presence of a PAD. Additionally, a review of all known PAD locations in Hampshire was undertaken, together with a survey of public areas where a PAD may be expected to be located. Results The current population of Hampshire is estimated to be 1.76 million. During the study period, 673 known PADs were located in 278 Hampshire locations. Of all calls confirmed as cardiac arrest (n=1035), the caller reported access to an automated external defibrillator (AED) on 44 occasions (4.25%), successfully retrieving and using the AED before arrival of the ambulance on only 18 occasions (1.74%). Conclusions Despite several campaigns to raise public awareness and make PADs more available, many public areas have no recorded AED available, and in those where an AED was available it was only used in a minority of cases by members of the public before arrival of the ambulance. Overall, a PAD was only deployed successfully in 1.74% OOH cardiac arrests. This weak link in the chain of survival contributes to the poor survival rate from OOH cardiac arrest and needs strengthening. [ABSTRACT FROM AUTHOR]

Background In November 2011, University Hospital Southampton (UHS), now a major trauma centre, opened its onsite helipad, allowing patients to be brought to the emergency department (ED) directly by air ambulance. Prior to this, helicopters were required to land at a local playing field and the patient had to be transferred by land ambulance. This study aims to investigate the impact this change in practice has had on the flow of patients to the ED. Methods The authors completed a retrospective case analysis of the first 100 patients brought directly to UHS by helicopter. Data were obtained from ED notes and helicopter provider databases. Analysis was conducted on the type of incident and appropriateness of referral. Incident locations were plotted geographically. Results 100 patients arrived at UHS ED by helicopter between 17 November 2011 and 31 March 2012. Of these, 79 were primary helicopter emergency medical service (HEMS) missions and 21 were secondary transfers from other hospitals. Of the HEMS patients, 38 were likely to have been transported to another hospital, had there not been an onsite helipad at UHS. 29 passed another suitable receiving hospital en route and therefore may have come to UHS for speciality services. Conclusions The provision of an onsite, 24 h helipad facility at UHS has resulted in a significant number of patients being transported to the hospital by helicopter who might otherwise have attended an alternative hospital. [ABSTRACT FROM AUTHOR]

Paramedic tracheal intubation has been practised in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcomes. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate, and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (eg, laryngeal mask airway), which were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative prehospital airway device for paramedics. [ABSTRACT FROM AUTHOR]

Presents letters to the editor concerning medical issues. Physicians' positioning of defibrillation paddles; Testing for Helicobacter pylori in dyspeptic patients; Lack of consensus in Ireland on neonatal vitamin K prophylaxis; Oxygen treatment for acute severe asthma; Others.

The article presents a study which examined the impacts of the 2006 World Cup football competitions on call volumes and profiles to apprehend how public events can influence demands on the ambulance service. Data relating to the calls are logged and saved on a mainframe computer. The results showed that call volume was over 50 percent higher on the day of the first football competition than that on a typical Saturday. It is concluded that mapping of limited resources will provide improved responses to emergency calls.

Reviews a statement on standards for cardiopulmonary resuscitation released by the Royal College of Anaesthetists, Royal College of London, the Intensive Care Society, and Resuscitation Council in Great Britain. Endorsement of the standards by several large health care organizations; Development of governmental policy on resuscitation; Recommendations of the statement for the administration of resuscitation in health care settings; Importance of funding for resuscitation personnel; Problems with acute health care identified by the statement; Key points and policies in the statement; Influence of the statement on health care services administration in Great Britain.

Questions whether doctors position defibrillation paddles correctly. How defibrillation is necessary to restore normal sinus rhythm in a patient having a ventricular fibrillation arrest; Methods and results; Conclusion.

Presents a study to determine the accuracy of Great Britain's advanced trauma life support guidelines for predicting systolic blood pressure by palpation of radial, femoral, and carotid pulses. Details of the study, which involved patients with hypotension secondary to hypovolemic shock; Conclusions regarding the inaccuracy of advanced trauma life support guidelines, which generally overestimate the patient's blood pressure.

Introduction Ambulance crews make 3.6 million emergency journeys each year. Effective patient transfer relies on verbal, non-verbal and documentary handover of complex information in time-limited environments. Weaknesses in ambulance handover have been noted but little work has been done to investigate the process and identify good practice. Research has looked at communication during transfer of care; standardised resuscitation handover formats have been used but do not always improve accuracy. Ineffective handover threatens patient safety, quality and efficiency of care. This study provides an in-depth examination of handover to inform practice and education. Method We are conducting an ethnographic case study of handover in an ambulance Trust. Researchers are accompanying crews as they undertake their day-to-day work, using observation and video-recording to capture handover—from data collection at scene, pre-alerting (by radio, telephone and computer) through to the hospital. We are also collecting information from patient records along with training materials, policies and directives pertaining to handover. Ethnography allows for informal conversations to take place as appropriate during the fieldwork to clarify understandings and explore emerging themes in the analysis. In addition we are using semi-structured interviews with patients, carers, ambulance staff, nurses, doctors and non-clinical hospital staff to explore the handover process. Result The project started 2nd April 2009. This poster will outline the methodology, present some of the emerging themes from our analysis and describe future data collection and analysis plans. Discussion This is an ongoing project. We will present our experience of undertaking this unusual project—especially issues surrounding accessing staff and the practicalities of data collection. By presenting this work we seek to inform future research into emergency care. [ABSTRACT FROM PUBLISHER]

Presents a letter to the editor about the risk of gastric inflation with ventilation techniques during cardiopulmonary resuscitation, and refers to a case report by Haslam et al.