The strategic and operational landscape of emergency services in the UK

Purpose: The organisational and service delivery landscape of the emergency services in the UK has been rapidly changing and is facing further change in the foreseeable future. This paper examines recent and ongoing organisational changes in the policy development, service delivery and regulatory landscape of the emergency services, in order to capture the overall picture and potential opportunities for improvement or further investigation. Design/methodology/approach: This general review utilises the characteristics of the three domains of a national framework, namely policy development, service delivery, and public assurance and uses these characteristics as lenses through which to examine the three main blue light emergency services of police, fire and ambulances. Findings: What emerges in the organisational landscape and conceptual maps for the police and even more so for Fire and Rescue Services, is the immaturity of many of the organisations in the policy and the public assurance domains while the service delivery organisations have remained relatively stable. In the relatively neglected ambulance services, we find the NHS’s recent Ambulance Response Programme has considerable potential to improve parts of all three domains. Research limitations/implications: The review is clearly limited to the UK and primarily focused on England. Practical implications: The review clearly identifies opportunities for improvement, potential improvement, and further research. Originality/value: Although the National Audit Office has attempted in the past to provide organisational landscape reviews of individual emergency services, this contemporary comparative review of all three services using a common model is unique. It provides considerable new insights for policy makers, service delivers and regulators

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

The research-practice gap in emergency services in England: expanding or contracting?

In the 2012 launch edition of the International Journal of Emergency Services (IJES), the authors published the first contribution to the journal which was entitled “Bridging the theory and practise gap in emergency services research: the case for a new journal” (Wankhade & Murphy 2012). As implied by its title, this inaugural editorial suggested that part of the rationale underpinning the new journal was the apparent ‘gap’ and silo ‘approach’ in academic publishing and consequentially the fragmented nature of the emergency services research. This alleged academic ‘gap’ had previously been articulated in some detail in the original proposals for the establishing the journal. “Emergency function resides with a host of agencies including the three “blue light” services (police, fire and ambulance). IJES is an opportunity to publish up‐to‐date and original research contributions for the benefit of scholars, policy makers and practitioners in these areas, including the interface of policy and practice at national, regional and global level” (Wankhade & Murphy 2012 p4). The journal was to “welcome articles examining the theory and practice of the strategic and operational management of emergency services and the related professional and policy aspects”. The purpose of this paper, which is being prepared to coincide with the 10th anniversary of the Journal is simply to revisit the alleged gap between research and practice in the three emergency services. At every conference, workshop or event that the authors have attended since that date (including attendance at every annual PAC conference), and notwithstanding whether the event was intended for a practitioner or for an academic audience, one implicit, but more often explicit, objective of our contributions has been to help to transcend this alleged gap. Adopting and adapting a mapping model developed by Dudau, Korac and Saliterer (2015) for the international investigation of a research-practice gap in accounting, that was subsequently published as ‘The Research Practise Gap on Accounting in the Public Services’ (Ferry et al 2019,) we will look initially at the state of engagement in the three emergency services in 2012 and compare this to the current situation. The paper therefore presents some initial evidence and interpretations which, we hope, will form the basis for debate and for more detailed investigation at a later stage. Our initial purpose is to test the model to see if it needs any refinement when applied to the emergency services in the UK

Zoonotic surveillance for rickettsiae in rodents and mapping of vectors of rickettsial diseases in India: A multi-centric study

Background: The global resurgence of rickettsial diseases and their potential to impact the fitness of military personnel and inflict widespread casualties amongst civil populations has emerged as a major cause of public health concern. Absence of surveillance system, lack of awareness amongst medical fraternity to rickettsial activity along with the difficulty in diagnosis because of their protean clinical manifestations are reasons for the outbreaks of these diseases. Objectives: To determine rickettsial activity amongst rodents and study vector diversity, abundance and their distribution to enable mapping of rickettsial hotspots. Methods: Zoonotic surveillance was undertaken in six selected study areas in India - Jammu, Akhnoor, Rajouri-Poonch, Udhampur-Nagrota, Dehradun and Pune. Weil–Felix test was used for rickettsial sero-surveillance amongst rodents and standard identification keys were used for mapping vector diversity and database preparation. Results: Serological findings revealed positivity to all the three rickettsial antigens (OXK, OX19 and OX2) in Jammu, OX19 in Dehradun and OXK and OX2 positivity in Udhampur-Nagrota belt. The vector database records presence of 16 species of trombiculid mites from three important genera - Leptotrombidium, Schoengastiella and Gahrliepia with ticks from five genera and 8 species of fleas from four genera. Mite fauna of study sites has been enriched with addition of new records of mite species (five mite species at Pune, two at Akhnoor with one mite species each at Jammu and Dehradun). Conclusion: The study reveals rickettsial activity amongst rodents at Jammu, Dehradun and Udhampur-Nagrota belt. The results correlate well with the presence of vectors of scrub and tick typhus and corroborate the occurrence of outbreaks of these diseases in the respective areas