Publications

INTRODUCTION: The return of spontaneous circulation (ROSC) care bundle is a set of interventions designed by NHS England for use in the post-resuscitation care of patients following out-of-hospital cardiac arrest (OHCA). Compliance with these standards is critical in providing optimal, standardised care and in improving outcomes. This study aimed to investigate the impact of critical care paramedics (CCPs) on delivery of post-ROSC care.

METHODS: A retrospective observational study was conducted across a large UK ambulance service. All patients with sustained ROSC following resuscitation for OHCA over a one-year period were included. The post-ROSC care delivered to two groups was compared - a standard care group, and a group where a CCP was present.

RESULTS: The study included 997 incidents: 106 incidents in the non-CCP group and 891 incidents in the CCP group. The presence of a CCP was associated with a statistically significant increase in compliance with the ROSC bundle. Of incidents with a CCP present, 75% were fully compliant, compared with 64% of incidents without a CCP. The mean percentage compliance across the standards was significantly higher in the CCP group. Secondary outcome analysis showed statistically significant benefits in compliance for several care parameters when a CCP was present.

CONCLUSION: This retrospective study confirms that the presence of a CCP improves delivery of post-ROSC care. This highlights the potential benefits of having CCPs as part of the standard pre-hospital care resuscitation team. Further research is needed to confirm these findings and to examine the relationship between the ROSC bundle and patient outcomes.

For humans, storing facial identities in visual working memory (VWM) is crucial. Despite vast research on VWM, it is not well known how face identity and physical features (e.g., eyes) are encoded in VWM representations. Moreover, while it is widely assumed that VWM face representations encode efficiently the subtle individual differences in facial features, this assumption has been difficult to investigate directly. Finally, it is not known how facial representations are forgotten. Some facial features could be more susceptible to forgetting than others, or conversely, all features could decay randomly. Here, we use a novel application of psychophysical reverse correlation, enabling us to estimate how various facial features are weighted in VWM representations, how statistically efficient these representations are, and how representations decay with time. We employed the same-different task with two retention times (1 s and 4 s) with morphed face stimuli, enabling us to control the appearance of each facial feature independently. We found that only a few features, most prominently the eyes, had high weighting, suggesting face VWM representations are based on storing a few key features. A classifier using stimulus information near-optimally showed markedly similar weightings to human participants-albeit weighing eyes less and other features more-suggesting that human VWM face representations are surprisingly close to statistically optimal encoding. There was no difference in weightings between retention times; instead, internal noise increased, suggesting that forgetting in face VWM works as a random process rather than as a change in remembered facial features.

INTRODUCTION: Providing feedback to emergency ambulance staff on performance or patient outcomes may improve care quality and professional development. Current feedback provision in ambulance services is limited and staff desire more feedback; however, we do not know what feedback would be most useful. This study aimed to determine the quality of feedback received by emergency ambulance staff, describe self-directed learning activities performed after receiving feedback (e.g. 'reflected on what exactly I did right/wrong') and identify situations where ambulance staff desired enhanced feedback.

METHODS: An observational mixed-methods study was used. Emergency ambulance staff delivering face-to-face patient care in the United Kingdom's National Health Service completed a baseline survey and diary entries between March and August 2022. Diary entries were event contingent and were collected when a participant identified that they had received feedback or desired feedback but had not received it. Free-text qualitative responses were categorised using content analysis before being included in the quantitative analyses. Quantitative data were analysed using descriptive and inferential statistics.

RESULTS: Baseline surveys were completed by 299 participants; 100 participants submitted 374 feedback-desired diary entries and 105 participants submitted 538 feedback-received diary entries. Ambulance staff expressed a statistically significant preference for patient-outcome feedback (77.8% [95% CI 74.0, 82.1]), provided by non-ambulance healthcare professionals (70.7% [66.2, 75.3]) and delivered electronically (54.0% [48.9, 59.4]). Feedback was particularly desired for cases involving neurological (17.1%) and cardiovascular (16.6%) conditions and non-conveyed patients (11.5%). Self-directed learning activities post feedback included reflection (61.5%), considering alignment with own judgement (41.1%) and discussions with colleagues (37.0%).

CONCLUSION: The study identifies critical gaps in current feedback practices within ambulance services and provides directions for feedback designs that would enhance existing systems and approaches. Training programmes should educate ambulance staff on effective feedback utilisation and management of both positive and negative feedback. Cultivating a supportive feedback culture within ambulance services is crucial for fostering continuous professional growth and improving patient care outcomes.

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) presents a significant public health challenge. Bystander utilisation of automated external defibrillators (AEDs) can improve survival. Drone delivery of AEDs may improve rates of bystander defibrillation. However, whereas most cardiac arrests occur in older people, there is minimal evidence on the perceptions of older people regarding AED delivery by drone. The aim of this study was to explore the perspectives of individuals aged 65 years and over on the use of drone technology for AED delivery in OHCA situations.

METHODS: Semi-structured qualitative interviews were undertaken to gather insights into participants' perceptions about drone AED delivery. Responses were thematically analysed.

RESULTS: Three main themes were identified from 12 interviews conducted between May and July 2024: (1) the interaction between the human and the drone; (2) perceived societal benefits of drone AED delivery for OHCA; and (3) safety and public perception. Participants expressed complex reactions to drone-delivered AEDs, and expressed concerns about correct AED usage and the emotional difficulty of leaving a patient unattended. Many anticipated guilt about possibly being unable to use the AED effectively in high-stress situations. Participants acknowledged the potential for drones to save lives by reducing response times in OHCA, but raised concerns about safety and public education. There was a strong consensus on the importance of public education and training to build confidence in using both AEDs and drone technology.

CONCLUSION: Although participants appreciated the rapid delivery of AEDs via drones for OHCA, they expressed significant concerns about their own ability to use the AED alongside the emotional burden associated with emergency situations. The findings emphasise the need for enhanced public education and psychological support to ensure effective bystander intervention in general. Additionally, prior to any roll-out of drone-delivered AEDs, there should be a specific programme of education to bridge the gap between technological acceptance and practical application.

INTRODUCTION: Unplanned pre-hospital births present one of the most challenging and complex incidents for ambulance personnel to attend. This rapid review aimed to consider the barriers to providing effective maternity care in the emergency pre-hospital setting.

METHODS: A rapid evidence review was performed using Medline and Cumulated Index to Nursing and Allied Health Literature Complete on studies dating between 2000 and 2024. A critical appraisal and thematic synthesis were also carried out. Qualitative studies written in English that considered staff and patient perspectives for pre-hospital maternity care were eligible for inclusion in this review.

RESULTS: Six studies were identified, and three analytical themes were generated: intrinsic, extrinsic and non-technical factors impacting obstetric care. Most ambulance clinicians felt insufficiently prepared for unplanned pre-hospital childbirth. Undergraduate-level training and continuing professional development opportunities were considered poor and were acknowledged as areas requiring improvement. Academic and ambulance service organisations should work towards addressing clinicians' lack of exposure to and confidence with maternity incidents.

CONCLUSION: Without regulatory and organisational input, unplanned pre-hospital births will continue to challenge both newly qualified and seasoned ambulance clinicians. There is an inherent need for revised maternity training standards for pre-hospital personnel that aims to address the barriers identified within this review paper. To set forth a provision of multidisciplinary and collaborative education opportunities, pre-hospital clinicians need to be acknowledged as key care providers for pregnant women in the emergency setting.

INTRODUCTION: The demographic of the paramedic workforce is changing on a worldwide scale, and a higher proportion of paramedics are women of childbearing age. In order to ensure retention in the workplace, it is crucial to understand the challenges faced by female paramedics when returning to work after maternity leave, thus guaranteeing that appropriate support can be provided. Due to a paucity of literature focusing on paramedics, this review has examined literature pertaining to other female healthcare professionals on their return to work and suggests that these factors affect women working in all healthcare disciplines, whether paramedic or otherwise.

METHODS: A systematic search strategy using four electronic databases (CINAHL, British Nursing Database, PubMed and Academic Search Complete) was conducted in February 2025. The PRISMA systematic approach was used to conduct a review of the literature, and selected studies were identified using predefined inclusion and exclusion criteria. Papers were narratively synthesised to produce key themes for discussion. As this was secondary research, no ethical approval was required.

RESULTS: A total of 746 records were initially found; after eliminating duplicates and giving consideration to titles and abstracts, 14 remained. Eight of the articles did not meet the inclusion criteria, leaving six, and a further three were found via snowballing and internet searches, giving a final total of nine articles for inclusion in the review. No literature that specifically related to female paramedics was found. Thematic analysis of the papers identified five main themes: work factors, health and well-being, childcare, identity and home support.

CONCLUSION: The factors that affect female healthcare workers on their return to work after maternity leave are multiple, complex and varied. Women need good support from their workplace in order to have a successful transition back to work, and the availability of childcare for shift workers was problematic. Further research is needed in this area to fully understand the issues facing female paramedics returning to work after maternity leave, as many papers identified were dated, and there is no contemporary UK data pertaining to female paramedics.

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in Europe. Early defibrillation is associated with improved outcomes. While this may be delivered by members of the public using an automated external defibrillator (AED), they are used infrequently. Drone delivery of an AED may enable quicker defibrillation compared to awaiting arrival of emergency medical services. Little is known about how members of the public may react to AED delivery or about the potential impact of retrieving an AED on the provision of high-quality cardiopulmonary resuscitation (CPR).

METHODS: A feasibility study using a simulated OHCA scenario was completed by members of the public. Participants performed CPR on a manikin, guided by an ambulance service call handler, which was interrupted by AED delivery. CPR quality and the duration of the interruption for AED retrieval were recorded, and participants' feedback on the scenario was collected using a survey.

RESULTS: Twelve participants completed the study. Overall, a median of 61% (interquartile range [IQR] 21-79) of chest compressions were delivered at the correct speed, and 99% (IQR 78-100) at the correct depth. CPR was discontinued for a median of 116 (96-135) seconds to retrieve an AED and deliver a shock. Participants described the scenario as stressful and challenging, were supportive of the concept of AED delivery by drone and emphasised the value of call-handler instructions and guidance.

CONCLUSION: This study demonstrated the feasibility of a process and outcomes evaluation of simulated drone-delivered AED to members of the public. The retrieval process was associated with notable interruption in the delivery of CPR, but it remains unknown whether any impact of this may be offset by expedited use of the AED. Understanding the likely overall impact of drone delivery of AEDs on patient outcomes is critical before this approach should be considered in clinical practice.

INTRODUCTION: Paramedics play an important role in addressing the growing demands in urgent and emergency care. Point-of-care testing (POCT) devices are increasingly portable and may assist with appropriate non-conveyance, but limited research exists to support this. This feasibility study aimed to inform the design of a larger study to determine whether it is practical for paramedics to use blood analysis POCT.

METHODS: An eight-month single-site feasibility sequential explanatory mixed-method study was conducted between April and December 2023, with a team of specialist paramedics who were provided with Abbott® i-STAT Alinity™ POCT devices with CHEM8+ and CG4+ cartridges. Using a qualitative evaluation of paramedic participants' experience with a POCT device and a descriptive analysis of case report forms and routine ambulance service data collection.

RESULTS: Seven specialist paramedics were recruited; 287 patients were screened, of which 252 (88%) were excluded and 35 (12%) were recruited. Lack of mental capacity excluded 76% of cases. The mean age was 82 years; 40% of participants were female and 60% were male. Hospital conveyance rates were four (11%) of the recruited patients. In those recruited and not conveyed, the median time on scene was 120 minutes. The success rate to obtain a test result at the first attempt was 81% (CHEM8+) and 84% (CG4+). Test result failure rates were 13% (CHEM8+) and 3% (CG4+). Focus group data revealed that paramedic participants considered POCT useful for decision making and the device procedures to be acceptable. Paramedics reported that extended time on scene was related to trial procedures and waiting times to discuss test results with healthcare professionals.

CONCLUSION: The POCT devices were acceptable and practical for use by our specialist paramedic participants. The results of this feasibility study should inform the design of a larger study to test the impact of using POCT, to understand challenges in recruitment and retention where POCT is utilised and to determine the clinical presentations where POCT can be applied.

Ethnic minorities are starkly underrepresented among paramedics in the UK, with their numbers significantly lower than in other allied healthcare professions. This disparity is not reflective of the diverse population the NHS serves. To achieve truly patient-centred care, the paramedic workforce must be representative of the communities it serves. This professional practice article aims to discuss the role of higher education institutions, NHS England and NHS ambulance trusts in addressing this issue. The article examines traditional entry routes to paramedic education and highlights financial constraints and limited entry points as significant barriers for aspiring paramedics from diverse backgrounds. Furthermore, a lack of ethnic diversity in paramedic leadership positions is identified as a discouraging factor. The article then critically appraises existing initiatives aimed at promoting diversity, such as the College of Paramedics' campaign. It acknowledges that raising awareness is a valuable step forward and advocates for a more comprehensive approach to achieve greater impact. The article lists some of the strategies employers could adopt to foster a more inclusive workplace culture and to support the career progression of paramedics from ethnic minority backgrounds. These strategies include targeted outreach programmes, mentorship initiatives, diversity and inclusion training for all staff and revisions to promotion policies. The article concludes by emphasising the need for a multi-pronged approach, involving collaboration between educational institutions, ambulance services, professional bodies and the government. Through implementing targeted recruitment strategies, fostering inclusive workplaces and providing career development opportunities, stakeholders can work together to build a more diverse and representative paramedic workforce, ultimately leading to improved equitable health outcomes at the individual, group and population level.