New study shows that one third of patients with diabetes attended by an ambulance for severe hypoglycaemia transported to hospital

EMAS - A&E 5A new study has been published in Primary Care Diabetes on ‘Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: a retrospective study’. Hypoglycaemia or low blood sugar is important because this may be linked to greater risk of death.

The study involved a new collaboration between the University of Leicester Cardiovascular and Diabetes group (Professors Kamlesh Khunti and Melanie Davies), University of Bristol (Harriet Fisher),  University of Queensland, Australia (Sanjoy Paul),University of Lincoln and East Midlands Ambulance Service NHS Trust (Mohammad Iqbal, Professor Niro Siriwardena).

The study aimed to report the characteristics, treatment and provider costs for people with diabetes requiring an emergency ambulance for severe hypoglycaemia and involved an analysis of routinely collected data on 90,435 emergency calls collected over four months by the East Midlands Ambulance Trust, UK.

There were 523 (0.6%) ambulance attendances for severe hypoglycaemia, with an incidence of 2.76 per 100 patient years: 28% of events occurred at night and 32% of those attended were transported to hospital. Those patients with a higher respiratory rate, indicating difficulty breathing, were more likely to be transported to hospital, whereas patients on treatment with insulin and those with higher blood glucose after treatment of hypoglycaemia were less likely to be transported to hospital.

Median ambulance costs were higher at £176 for individuals not transported to hospital whereas those transported cost £92 reflecting the greater time ambulance staff spent with patients who were enabled to remain at home.

The research team are planning further studies investigating longer term outcomes of prehospital care for hypoglycaemia as part of CaHRU’s Prehospital and Emergency Quality and Outcomes (PEQO) programme.

New study published on how acute pain management could be improved in urgent care

Mohammad Iqbal, research fellow and PhD student at the University of Lincoln and research associate at East Midlands Ambulance Service (EMAS), together with Anne Spaight (senior research fellow at the University of Lincoln and Head of Clinical Governance, Audit and Research at EMAS) and Niro Siriwardena (professor of primary and prehospital health care) have a new study published online in the Emergency Medical Journal. The study entitled: ‘Patients’ and emergency clinicians’ perceptions of improving pre-hospital pain management: a qualitative study’  follows on from an earlier study investigating prehospital pain management which showed that under two-fifths of patients with a painful condition (heart attack or fracture) were provided with pain relief.

Although patients and staff expected pain to be relieved in the ambulance, refusal of or inadequate analgesia were common. Pain was often assessed using a verbal pain score, but practitioners’ views of severity were sometimes different from patients’ views. Morphine and Entonox were commonly used to treat pain, but reassurance, positioning and immobilisation were used as alternatives to drugs.

The authors concluded that pre-hospital pain management could be improved by addressing practitioner and patient barriers, increasing available drugs and developing multi-organisational pain management protocols supported by training for staff. These findings may be used to inform guidance, education and policy to improve the pre-hospital pain management pathway.

Niro Siriwardena co-leads the NIHR Programme Grant for Applied Research: Prehospital Outcomes for Evidence based Evaluation (PhOEBE).