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Open accessEditorialFirst published March, 2024pp. 48-51
Open accessResearch articleFirst published March, 2024pp. 52-65Sepsis is an increasingly common presentation to which ambulance resources are dispatched. Whilst early administration of antibiotics (AB) has been associated with improved outcomes, the impact of prehospital administration in an ambulance service context appears uncertain. This systematic review aimed to compare the effect of prehospital administration of antibiotics together with usual care (oxygen and intravenous fluids), to usual care alone, on mortality for patients with sepsis. A systematic review was conducted adherent to JBI methodology. Studies were eligible for inclusion if they were published after 2000; conducted in the prehospital setting; compared AB plus usual care to usual care alone in the prehospital phase; and reported an outcome of mortality at any time point. Systematic searches of Medline, CINAHL, EMBASE and Google Scholar were conducted, with included articles subjected to quality assessment using JBI appraisal tools. Each stage was completed by two authors, with a third engaged to resolve conflicts. A narrative synthesis was conducted and reported, and certainty of evidence was assessed. Of 587 studies identified from the searches, five satisfied the inclusion criteria and were included in the data synthesis. Two were randomized controlled trials, and three used observational comparative designs assessed as being at low-to-moderate risk of bias. Regarding the primary outcome of mortality, there was no evidence from high-quality studies with a low risk of bias that prehospital administration of ABs decreased mortality when measured at 28, 30 or 90 days. Regarding secondary outcomes, there was no evidence from high-quality studies with a low risk of bias that prehospital ABs reduce the length of stay in the hospital generally or the intensive care unit. The certainty of findings was low for mortality at 90 days, and very low for measurement at 28 and 30 days. There was insufficient evidence from high-quality studies with a low risk of bias indicating prehospital administration of ABs in addition to usual care, compared to usual care alone, reduces mortality at 28, 30 or 90 days, or length of stay in hospital or ICU, for adult patients with sepsis. There is insufficient evidence to enable the recommendation of routine administration of antibiotics to patients with sepsis presenting to ambulance service clinicians in the prehospital setting. Investigation of administration to more severe sepsis presentations in settings where prolonged prehospital intervals are inherent is warranted.
Open accessResearch articleFirst published March, 2024pp. 66-78, Eystein Grusd, Don Rice , [...]Improved prehospital systems are contributing to increased presentations of CPR-Induced Consciousness (CPRIC). Data registries do not report CPRIC presentations and thus continued lack of evidence exists, causing a significant variation of prehospital CPRIC management guidelines. The result is variation in recognizing and managing CPRIC. Steps are needed to improve knowledge of CPRIC and model evidence-based guidelines.
An international panel of experts was recruited to create CPRIC definitions, guidelines, and a reporting framework which can be used for reporting purposes.
A Delphi methodology was used to gain consensus, defined as ≥70% agreement rate, on three domains or areas of interest: Definition, management guideline and data reporting. Participants were invited from the author's professional organizations, as well as social media outlets to recruit as many international clinicians as possible. The study administered four rounds of online surveys. Each round had multiple consensus statements for participants to respond to.
Eighty-two percent of panelists reported seeing or managing CPRIC suggesting either improved awareness or increased exposure. Consensus was achieved in all three domains. There was agreement on a clear definition of CPRIC. The panel developed two subgroups of CPRIC; interfering and non-interfering CPRIC. Ketamine was the preferred choice to treat CPRIC. Panelists overwhelmingly felt CPRIC needed to be included into the Utstein guidelines.
This study successfully created definitions of CPRIC, management guidelines, and a data reporting framework. Using this study as a building block, the study team hopes stronger, evidence-based guidelines can now be researched and published.
Open accessResearch articleFirst published March, 2024pp. 79-88Chronic pain is highly prevalent among the global population and has a significant impact on a patient's livelihood in multiple areas. Chronic pain is now more widely recognised as a standalone medical condition by most healthcare disciplines, separate from that of acute pain. This has allowed for the development of a unique evidence-based approach to caring for these patients, which incorporates the biological, psychological, and social dimensions in which chronic pain transverses. However, in the paramedic practice setting, chronic pain has received scant mention. This knowledge gap leaves many paramedics operating without guidelines suitable for the care of chronic pain patients or an epidemiological foundation describing the incidence or treatment requirements of this patient cohort. Most importantly, the perspectives and experiences of chronic pain patients who are treated by paramedics have yet to be investigated which is vital to ensure relevant care.
To describe and understand the experience of patients requiring ambulance attendance for chronic pain-related complaints.
Six participants were enlisted using convenience sampling. Participants responded, via Zoom, to an inductive, semi-structured interview. Analysis was performed using qualitative reflexive thematic analysis with a non-positivist, constructive approach.
The themes identified were ‘the impact of stigma’ and ‘inadequate paramedic education’. Most participants shared similar attitudes and experiences regarding paramedic management, expressing dissatisfaction with the current standard of practice in relation to chronic pain complaints.
Patients experiencing chronic pain are underserved by the standard of care being offered in this practice setting. Concerns raised by patients centred around the impact both stigma and educational understanding have on treatment. These findings indicate a need for further research, including the revision of guidelines and consideration of the patient perspective to be conducted in this area.