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Background Pulseless electrical activity (PEA) is managed in accordance with international and national guidelines. These guidelines are not fully evidenced, resulting in emergency medical services in the United Kingdom amending guidelines to support paramedics when making resuscitation decisions. This review examined the local guidelines of services to identify the local clinical management of PEA, summarise the available evidence and prioritise future research. Methods The review was conducted according to the Joanna Briggs Institute systematic review of text and opinion. The review included locally amended guidelines and cited evidence sources for the management of PEA. A three-step search strategy was applied. Textual data was extracted to form conclusions which were categorised into similar meaning and developed into synthesised findings. Results Twenty-two documents met the inclusion criteria; Twenty-seven conclusions were extracted and analysed to generate 10 categories, forming three synthesised themes: the variability in the clinical management of PEA between ambulance services; the early identification of reversible causes and appropriate treatment options to increase survivability; and the consensus for further research. Conclusion This review identified variability in the clinical management of PEA; the autonomy of paramedics, which patients to transport to hospital and the factors applied to inform resuscitation decisions. A summary of the evidence in support of the local guidelines found that the early identification and treatment to reverse the cause of PEA was important to patient survival, however, this was acknowledged as complex and challenging to achieve. There was a consensus to improve patient outcomes using prognostic research.

BackgroundDrug poisoning deaths in England and Wales have increased by 52% since 2011 with over half involving opioids. Deaths are preventable if naloxone is administered in time. Take Home Naloxone (THN) kits have been distributed through drug services; however, uptake is low and effectiveness unproven. The TIME trial tests the feasibility of conducting a full randomised controlled trial of providing THN administration and basic life support training to high-risk opioid-users in emergency care settings.MethodsA multi-site feasibility trial commenced in June 2019 with two hospitals and their surrounding ambulance services (Bristol Royal Infirmary (BRI) with South Western Ambulance NHS Foundation Trust (SWASFT) and Hull Royal Infirmary with Yorkshire Ambulance Service) randomly allocated to intervention arms; and sites in Wrexham and Sheffield allocated as ‘usual care’ controls. SWASFT began recruiting in October 2019 with the aim of recruiting and training 50% (n=111) of paramedics working within the BRI’s catchment area, to supply THN to at least 100 eligible patients during a 12-month period.ResultsThe trial was suspended between 17.03.2020-06.08.2020 and extended to 01.03.2021 (COVID-19). Despite this, 121 SWASFT paramedics undertook TIME training. TIME trained paramedics attended 30% (n=57) of the n=190 opioid-related emergency calls requiring naloxone administration during the study period. A total of n=29 potentially eligible patients were identified before and n=28 after the COVID-19 suspension. Two patients were supplied with THN during each period. During the COVID-19 suspension, twenty-two potentially eligible patients were missed. The majority of eligible patients presented with a reduced consciousness level, preventing recruitment (73%; n=42/48). These patients were transported to hospital for further treatment (n=39) or died on scene following advanced life support (n=3).ConclusionsThe lowered consciousness levels of prehospital emergency ambulance patients who present with opioid poisoning, often prevent the delivery of training required to enable the supply of THN.

BackgroundIn the United Kingdom, out of hospital cardiac arrest patients with pulseless electrical activity (PEA) have a poor survival to discharge rate of 5.3%.1 PEA is managed according to national guidelines.2 These guidelines are imperfect due to limited research resulting in ambulance services locally amending guidelines to support resuscitation decisions.3 This review aimed to examine the local guidelines of UK ambulance services for the management of PEA.MethodsA three-step search strategy was applied from August 2020 to October 2020. 1) A search of UK ambulance service websites was conducted to identify published local guidelines. Where guidelines were not available a written request was made for the guideline, associated guideline or a narrative summary in the absence of a guideline. 2) Documents referenced within the local guidelines specific to pulseless electrical activity were identified and extracted as supporting literature. 3) Documents referenced in the supporting literature identified as having pulseless electrical activity in the title were extracted.ResultsTwenty-two documents of textual data met the inclusion criteria. Twenty-nine conclusions were extracted and analysed to generate ten categories, forming three synthesised themes relating to the variability in the clinical management of PEA between UK ambulance services, the early identification of reversible causes and appropriate treatment options to increase survivability and the consensus for further research.ConclusionComprehensive national guidelines are lacking due to limited research. The local clinical guidelines and practices of UK ambulance services which aim to address the gaps in research, introduce variability in the management of pulseless electrical activity. Early identification and treatment to reverse the cause of pulseless electrical activity was highlighted to improve patient survival, however, this was complex and challenging to achieve during pre-hospital resuscitation. There was a consensus in the paucity of evidence and the potential for future prognostic research to improve patient outcomes.

BackgroundMental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, staff experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. To identify whether organisational support meets staff needs, this research explored the perceptions and experiences of staff working in a large ambulance trust covering the south west of England.MethodsBetween September and October 2018, ambulance staff were invited to complete an online questionnaire, which assessed demographics, work-related stressful life events, related psychological impact assessed by the avoidant subscale of Weiss and Marmar’s Impact of Event Scale-Revised, mental ill health sickness absence during the previous 12 months, perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time-to-talk at work.ResultsOver 11% (N=540) of the workforce responded. The majority reported experiencing work-related stressful life events (n=444; 82%), that were associated with subsequent avoidant symptoms. Avoidant symptom severity peaked between six-months to five-years after an event (F (5,438) = 2.4, p=0.03), was associated with repeated exposure (F (4,439) = 2.9, p=0.01) and to sickness absence. A fifth of participants reported mental ill health sickness absence (21.6%), a third of which was not disclosed as related to mental health. Content analysis identified stigma, fear, as well as embarrassment, as barriers to disclosure and help-seeking. Perceptions and experiences of organisational support were significantly correlated (r (195) =0.46, pConclusionsSymptoms associated with work-related stressful life events can persist for years among ambulance staff. Given the association between organisational support and mental wellbeing, it is possible that an intervention, such as mandatory time-to-talk, supported at an organisation level could improve wellbeing among ambulance staff. Such an intervention needs to be evaluated in future research.