In the Wake of the Storm: Environment, Disaster, and Race After Katrina

Studies evidence of environmental disparities by which poor and minority communities are disproportionately exposed to disasters, are less prepared, and have less access to relief agencies. Makes recommendations for preparedness and environmental justice

Calculating real-world travel routes instead of straight-line distance in the community response to out-of-hospital cardiac arrest

Using straight-line distance to estimate the proximity of public-access Automated External Defibrillators (AEDs) or volunteer first-responders to potential out-of-hospital cardiac arrests (OHCAs) does not reflect real-world travel distance. The difference between estimates may be an important consideration for bystanders and first-responders responding to OHCAs and may potentially impact patient outcome. To explore how calculating real-world travel routes instead of using straight-line distance estimates might impact the community response to OHCA. We mapped 4355 OHCA (01/04/2016-31/03/2017) and 2677 AEDs in London (UK), and 1263 OHCA (18/06/2017-17/06/2018) and 4704 AEDs in East Midlands (UK) using ArcGIS mapping software. We determined the distance from OHCAs to the nearest AED using straight-line estimates and real-world travel routes. We mapped locations of potential OHCAs (London: n = 9065, 20/09/2019-22/03/2020; East Midlands: n = 7637, 20/09/2019-17/03/2020) for which volunteer first-responders were alerted by the GoodSAM mobile-phone app, and calculated response distance using straight-line estimates and real-world travel routes. We created Receiver Operating Characteristic (ROC) curves and calculated the Area Under the Curve (AUC) to determine if travel distance predicted whether or not a responder accepted an alert. Real-world travel routes to the nearest AED were (median) 219 m longer (623 m vs 406 m) than straight-line estimates in London, and 211 m longer (568 m vs 357 m) in East Midlands. The identity of the nearest AED changed on 26% occasions in both areas when calculating real-world travel routes. GoodSAM responders' real-world travel routes were (median) 222 m longer (601 m vs 379 m) in London, and 291 m longer (814 m vs 523 m) in East Midlands. AUC statistics for both areas demonstrated that neither straight-line nor real-world travel distance predicted whether or not a responder accepted an alert. Calculating real-world travel routes increases the estimated travel distance and time for those responding to OHCAs. Calculating straight-line distance may overestimate the benefit of the community response to OHCA

Workshop report: land use decision-making for biomass deployment, bridging the gap between national scale targets and field scale decisions

The workshop brought together 74 attendees representing stakeholders from academia, industry (including biomass suppliers, agricultural consultancies, and end-users), NGOs and government (with representation from the England, Scotland and Welsh governments). Attendees contributed comments and recommendation on three questions relating to land suitability, barriers to growth of the sector, and tools needed to support stakeholder decisions around deployment

Trends in use of intraosseous and intravenous access in out-of-hospital cardiac arrest across English ambulance services : a registry-based, cohort study

Introduction: The optimum route for drug administration in cardiac arrest is unclear. Recent data suggest that use of the intraosseous route may be increasing. This study aimed to explore changes over time in use of the intraosseous and intravenous drug routes in out-of-hospital cardiac arrest in England. Methods: We extracted data from the UK Out-of-Hospital Cardiac Arrest Outcomes registry. We included adult out-of-hospital cardiac arrest patients between 2015–2020 who were treated by an English Emergency Medical Service that submitted vascular access route data to the registry. The primary outcome was any use of the intraosseous route during cardiac arrest. We used logistic regression models to describe the association between time (calendar month) and intraosseous use. Results: We identified 75,343 adults in cardiac arrest treated by seven Emergency Medical Service systems between January 2015 and December 2020. The median age was 72 years, 64% were male and 23% presented in a shockable rhythm. Over the study period, the percentage of patients receiving intraosseous access increased from 22.8% in 2015 to 42.5% in 2020. For each study-month, the odds of receiving any intraosseous access increased by 1.019 (95% confidence interval 1.019 to 1.020, p < 0.001). This observed effect was consistent across sensitivity analyses. We observed a corresponding decrease in use of intravenous access. Conclusion: In England, the use of intraosseous access in out-of-hospital cardiac arrest has progressively increased over time. There is an urgent need for randomised controlled trials to evaluate the clinical effectiveness of the different vascular access routes in cardiac arrest

What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

Background Emergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern. Our objectives were to describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation. Method We conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach. Results Twelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600–900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre; contact made with callers; and their General Practitioner (GP) with an aim of discouraging further calls, to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. Although data were available related to volume of calls and number of callers meeting the threshold for definition as Frequent Caller, no formal audits or evaluations were reported. Conclusions Ambulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Multi-disciplinary case management approaches may help to provide appropriate care, and reduce demand on emergency services. However, there is currently inadequate evidence to inform commissioning, policy or practice development

A qualitative study of ambulance personnel, care staff and service users’ experiences and perceptions of emergency care in care homes

Background Medical emergencies in care homes are common and costly, often resulting in calls to emergency services, ambulance attendance, conveyance, and hospital admissions. Over half of emergency transfers to hospital could be prevented with better ongoing care, access to primary care and training of staff. Our aim was to explore ambulance staff experiences of emergencies in care homes. Methods We employed a qualitative design. The study involved semi-structured interviews with ambulance staff working at the East Midlands Ambulance Service NHS Trust. Data were analysed thematically using a framework approach. Results We interviewed 15 ambulance staff (including paramedics, technicians, urgent care assistants). Preliminary analysis showed that although good communication with care home staff was considered important, experiences were varied. The importance of good, adequate resident information ready for ambulance staff upon arrival was highlighted. Regarding the decision-making process, participants reported consulting with everyone involved (care home staff, residents, relatives) and making final decisions based on various factors, including the resident/their family’s wishes, medical history, ReSPECT forms, alternative pathways to A&E, and what they considered the most appropriate course of action for the resident. Care home-related factors (access/egress issues; staff training; policies and procedures; and overall quality of care) and Emergency Medical Services-related factors (current pressures on the service; better training needed on working with people with dementia, end-of-life care, etc.; having access to an on-call geriatrician), which impact those who experience emergencies in care homes, were also discussed. Conclusion This study highlights the main challenges and facilitators that ambulance staff are faced with when dealing with emergencies in care homes. These data present findings of one staff group and triangulation with care home staff, resident and family perspectives would generate further insights. The findings will inform the development of interventions to improve outcomes and experiences of emergencies in care homes

Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)

© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).AIMS: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest. METHODS: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained. CONCLUSION: The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered.Peer reviewe