Viet-Hai Phung presented his work on the perceptions and experiences of Community First Responders (CFRs) in Lincolnshire at the recent Mediterranean Emergency Medicine Congress (MEMC). The Congress, organised by the American Academy of Emergency Medicine (AAEM), took place in the very smart surroundings of the Corinthia Hotel in Lisbon, Portugal from 8-10 September 2017. Despite the title of the Congress, this was a truly international conference, with delegates from North America, the Middle East, Africa and Australasia presenting.
Professor Lee Alan Wallis, Head of Emergency Medicine for the Western Cape Government, was the keynote speaker at the opening ceremony. He talked about the particular challenges of emergency medicine provision in southern Africa, where in some countries the infrastructure is extremely basic. Other plenary speakers included: Professor James Ducharme from McMaster University in Toronto, who talked about the complex relationship between pain relief, patient satisfaction and addiction and Dr Eveline Hitti from the American University in Beirut, who spoke about the glass ceiling for women working in emergency medicine.
Viet-Hai presented the interview study that has been undertaken with colleagues Prof Niro Siriwardena, Ian Trueman and Prof Roderick Ørner on the first morning of the conference. The presentation was well-received with only minor points of clarification from the audience concerning the extent of their use in the UK and the levels of training they undertake.
What was interesting about the conference was the sharing of best practice from around the world on many salient problems in emergency medicine, such as alleviating patient overcrowding in the emergency department. All this within the setting of the wonderful city of seven hills, Lisbon.
By Viet-Hai Phung
Three members of the CaHRU team, Professor Niro Siriwardena, Dr Stephanie Armstrong and Greg Whitley (paramedic and doctoral student) led an interactive exploration of the latest research and innovation in ambulance care in a session entitled ‘Innovations in ambulance service care: ‘bangs, brains and hearts’ as part of the Lincoln Get Hold of Technology and Science (LiGHTS) Expo on 29 September 2017.
The seminar was presented twice to around 40 members of the public in all aged 7 to 60+ years. It explored the kind of care we can expect currently from ambulance services. The team explained how today’s ambulance service is about far more than transporting people to hospital. Prof Siriwardena discussed how ambulance services should be measured using an animation from the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. Steph Armstrong discussed ‘Why do ambulance research and how difficult is it?’ exploring the difficulties of randomising patients and gaining consent in this setting. Prof Siriwardena then spoke about the use of GTN (also known as nitroglycerine, a component of dynamite) for stroke in the RIGHT2 trial and Greg Whitley, paramedic on the AIRWAYS2 trial explained the different airways device being tested in the study.
The seminar continued with a hands-on exercise involving cardio-pulmonary resuscitation, looking at airway devices and listening to heart sounds with a stethoscope. There was also plenty of audience participation with questions, answers and prizes! Prof Siriwardena and Dr Stephanie Armstrong gave an interview to Melvyn Prior at BBC Radio Lincolnshire as part of the event.
Two key articles on development and prioritization of new ambulance performance measures were published this autumn 2017 in Health Expectations. The studies come from, Prehospital Outcomes for Evidence Based Evaluation (PhOEBE), funded by a five year National Institute for Health Research Programme Grant for Applied Health Research led by Professor Niro Siriwardena from CaHRU and Janette Turner of the Centre for Urgent and Emergency care research (CURE).
The first article, ‘Prioritizing novel and existing ambulance performance measures through expert and lay consensus: a three-stage multimethod consensus study‘ involved a multistakeholder consensus event, modified Delphi study, and patient and public consensus workshop, which together identified a shortlist of ambulance outcome and performance measures important to ambulance clinicians and service providers, service users, commissioners and academics.
The final set of measures included change in pain score, accuracy of call identification, average response time, proportion of patients with a serious condition who survived to 7 days post-admission, death (within 3 days) from a low risk condition, proportion of patients transported to the Emergency Department who were discharged without treatment or investigation, and the proportion of those with specific conditions treated according to current guidelines.
The public consensus workshop, ‘A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures‘, was effective for obtaining public feedback on which ambulance performance measures were most highly favoured by lay participants. These measures have been developed to be used in future by ambulance services or commissioners to benchmark care quality between services or regions or to measure performance over time.
By Prof Niro Siriwardena
CaHRU are pleased to announce the first publication from the Wellcome Trust funded project, NEAT: Network exploring Ethics in Ambulance Trials. The article, entitled ‘Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review‘, sought to understand the main ethical considerations when conducting clinical trials involving ambulance services.
The review found issues with consent were the most significant ethical issue for ambulance trials. The type of consent gained differed depending on the condition or intervention being studied, but the country in which the research took place had less influence on the type of consent. The terminology used to describe consent varied widely with multiple terms used to describe the same processes. This, coupled with the the wide range of consent types used led to the conclusion that standardisation of consent models and terminology used to describe them was warranted.
The systematic review was published in BMC Medical Research Methodology and is available open access at the following link: http://rdcu.be/vUxW
By Stephanie Armstrong.
Viet-Hai in his new role as Research Assistant
A new study entitled, ‘Community First Responders (CFRs) and schemes in the United Kingdom: systematic scoping review‘, conducted by members of CaHRU was published on 19th June 2017 in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. This article was the culmination of an initial idea for research proposed by Ian Trueman from the School of Health and Social Care. He undertook the scoping review with former colleague, Fiona Togher. Viet-Hai Phung took over from Fiona after the scoping review was completed and subsequently led writing the paper, with substantial constructive comments from Ian, Professor Niro Siriwardena and Dr Roderick Ørner, a consultant psychologist.
From an initial search of six databases, 15,696 publications were identified as being potentially relevant. After several stages of screening by title and abstract, narrowing the geographical focus and for relevance of content, as well as removing duplicates and full-text screening, nine studies were included in the final analysis.
A number of key themes were identified by the nine publications. The study showed that people were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low with patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles.
These findings establish a baseline of evidence on the work of CFRs in the UK. The team are building on this by undertaking an interview study of CFRs. Opportunities for future research include exploring the experiences and perceptions of patients who have been treated by CFRs as well as other stakeholders, including ambulance staff, while also evaluating the effectiveness and costs of CFR schemes.
By Viet-Hai Phung