Viet-Hai Phung

Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study

There is an increasing need to assess the performance of emergency ambulance services using measures other than the time taken for an ambulance to arrive on scene. In line with government policy, patients and carers can help to shape new measures of ambulance service performance.

Ethnicity, migration and employment disadvantage under New Labour: reviewing the evidence from the United Kingdom

Despite economic growth and extensive labour market interventions, the employment disadvantage faced by ethnic minorities and migrants in the UK changed little under the previous Labour Government. Ethnic minorities and migrants in the UK are still significantly less likely to be in employment and are more likely to be unemployed than the majority white population. The key explanatory factors are often inter-connected and include: geographical deprivation; deindustrialisation; education; limited social capital; large families; inaccessible childcare; ill-health; ethnic penalties and discrimination; and restrictive asylum policies. That such employment disadvantage still exists in the UK suggests that the previous Labour Governments policies were insufficiently effective. This demands a new approach that increases the opportunities available to ethnic minorities and migrants to enable them to achieve labour market success. With this in mind, the UKs new Coalition Government should consider interventions that aim to level up employment opportunities for these groups by recognising that some labour market disadvantages are common across all ethnic groups, while others are more relevant for particular ethnic groups. The article focuses on Pakistanis, Bangladeshis and Black Caribbeans, as well as asylum seekers and refugees, because they are some of the most disadvantaged ethnic and migrant groups in the UK. In doing so, it is important to recognise that the majority white population, the ethnic minority and migrant populations cannot be treated as separate homogeneous entities because the reality is much more nuanced.

Ethnicity and Child Poverty under New Labour: A Research Review

This review article explores the evidence on child poverty rates amongst different ethnic groups in the UK. The Labour Government aims to end child poverty by 2020. Its strategy rests on improving employability, making work pay and expanding childcare provision. But child poverty rates among ethnic minorities are higher than among white people, which suggests that policies to reduce these have been ineffectual. The factors underlying this differential include labour market disadvantage, insensitive mainstream services and the language barriers that may cause low take-up of services, benefits and tax credits. The article concludes by suggesting a number of policy strategies that government could take to reduce the levels of child poverty amongst ethnic minorities.

Community first responders and responder schemes in the United Kingdom: systematic scoping review

BackgroundCommunity First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK. There has been no previous review of UK literature on these schemes. This is the first systematic scoping review of UK literature on CFR schemes, which identifies the reasons for becoming a CFR, requirements for training and feedback and confusion between the CFR role and that of ambulance service staff. This study also reveals gaps in the evidence base for CFR schemes.MethodsWe conducted a systematic scoping review of the published literature, in the English language from 2000 onwards using specific search terms in six databases. Narrative synthesis was used to analyse article content.ResultsNine articles remained from the initial search of 15,969 articles after removing duplicates, title and abstract and then full text review.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. There were concerns about the possible emotional impact on CFRs responding to incidents. 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, patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles. There was support for local autonomy of CFR schemes but with greater sharing of best practice.DiscussionMost studies dated from 2005 and were descriptive rather than analytical. In the UK and Australia CFRs are usually lay volunteers equipped with basic skills for responding to medical emergencies, whereas in the US they include other emergency staff as well as lay people.ConclusionOpportunities for future research include exploring experiences and perceptions of patients who have been treated by CFRs and other stakeholders, while also evaluating the effectiveness and costs of CFR schemes.

Ethnicity and pre‐hospital care for people with suspected cardiac pain: cross‐sectional study

Abstract Objectives Few studies have investigated the quality of pre‐hospital care by ethnicity. We aimed to investigate ethnic differences in pre‐hospital ambulance care of patients with suspected cardiac pain. Methods We conducted a cross‐sectional analysis of retrospective electronic clinical data for patients with suspected cardiac pain over one year (August 2011 to July 2012) extracted from a single regional ambulance service. This included patient demographic data, clinical measurements, drugs administered and outcomes, such as transportation to hospital or referral to primary care. We used multivariate regression to investigate differences in care by ethnicity comparing non‐White with White patients. Results There were 7046 patients with suspected cardiac pain, with 4825 who had ethnicity recorded including 4661 (96.6%) White and 164 (3.4%) non‐White. After correcting for age, sex, socio‐economic status and whether transported to hospital, non‐White patients were significantly more likely to have temperature [odds ratio (OR) 2.96, P = 0.007], blood glucose (OR 3.95, P = 0.003), respiratory rate (OR 4.94, P = 0.03) and oxygen saturation (OR 2.43, P = 0.006) recorded. Non‐White patients were significantly less likely to be transported to hospital (OR 0.43, P = 0.03). Conclusion There were significant differences in pre‐hospital ambulance care for non‐White compared with White patients with suspected cardiac pain. These differences could be due to differences in clinical condition or case‐mix, language and cultural barriers, limited understanding of appropriate use of health care services, recording bias or true differences in provider management. Further analysis should involve larger and more complete data sets to explore ethnic differences in greater detail.

Perceptions and experiences of community first responders on their role and relationships: qualitative interview study

BackgroundCommunity First Responders (CFRs) are lay volunteers who respond to medical emergencies. We aimed to explore perceptions and experiences of CFRs in one scheme about their role.MethodsWe conducted semi-structured interviews with a purposive sample of CFRs during June and July 2016 in a predominantly rural UK county. Interviews were transcribed verbatim and analysed using the Framework method, supported by NVivo 10.ResultsWe interviewed four female and 12 male adult CFRs aged 18–65+ years with different levels of expertise and tenures. Five main themes were identified: motivation and ongoing commitment; learning to be a CFR; the reality of being a CFR; relationships with statutory ambulance services and the public; and the way forward for CFRs and the scheme. Participants became CFRs mainly for altruistic reasons, to help others and put something back into their community, which contributed to personal satisfaction and helped maintain their involvement over time. CFRs valued scenario-based training and while some were keen to access additional training to enable them to attend a greater variety of incidents, others stressed the importance of maintaining existing abilities and improving their communication skills. They were often first on scene, which they recognised could take an emotional toll but for which they found informal support mechanisms helpful. Participants felt a lack of public recognition and sometimes were undervalued by ambulance staff, which they thought arose from a lack of clarity over their purpose and responsibilities. Although CFRs perceived their role to be changing, some were fearful of extending the scope of their responsibilities. They welcomed support for volunteers, greater publicity and help with fundraising to enable schemes to remain charities, while complementing the role of ambulance services.DiscussionCFR schemes should consider the varying training, development and support needs of staff. CFRs wanted schemes to be complementary but distinct from ambulance services. Further information on outcomes and costs of the CFR contribution to prehospital care is needed.ConclusionOur findings provide insight into the experiences of CFRs, which can inform how the role might be better supported. Because CFR schemes are voluntary and serve defined localities, decisions about levels of training, priority areas and targets should be locally driven. Further research is required on the effectiveness, outcomes, and costs of CFR schemes and a wider understanding of stakeholder perceptions of CFR and CFR schemes is also needed.

Prioritizing novel and existing ambulance performance measures through expert and lay consensus: a three-stage multimethod consensus study

Current ambulance quality and performance measures, such as response times, do not reflect the wider scope of care that services now provide. Using a three‐stage consensus process, we aimed to identify new ways of measuring ambulance service quality and performance that represent service provider and public perspectives.

Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Objective: We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation. Methods: We used a cross‐sectional design with a 7‐day retrospective sample of adults aged 18years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0–10 numerical verbal pain score [NVPS]). Results: We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff. Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p<0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75). Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P<0.01), attending patients aged 51 to 64years (OR 2.04, 95% CI 1.21 to 3.45, p=0.01), in moderate to severe (NVPS 4–10) compared with lower levels of pain for any clinical condition group compared with the reference condition. Conclusion: There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.

PP29 Exploring factors increasing paramedics’ likelihood of administering analgesia in pre-hospital pain: cross sectional study (explain)

Background Paramedics play an important role in reducing pain in patients calling an ambulance. We aimed to identify how patient factors (age, sex), clinical condition and paramedic factors (sex, role seniority) affected pain treatment and outcomes. Methods We used a cross sectional design using routine retrospective data a one-week sample of all 999 ambulance attendances in two large regional UK ambulance services for all patients aged 18 years or over where pain was identified in people requiring primary transport to hospital. Exclusion criteria patients with a Glasgow Coma Scale score below 13, or patients not attended by a paramedic. We used a multilevel design, using a regression model to investigate which factors were independently associated with administration of analgesia and reduction in pain, taking into account confounders including patient demographics and other variables. Analysis was performed with Stata. Results We collected data on 9574 patients (service 1, 2; n=3344, 6230 respectively) including 4911 (51.3%) male and 4524 (47.3%) females (1.5% missing). Initial pain score was not recorded in 42.4% (4063/9574). The multilevel model suggested that the factors associated with use of strong opiates (morphine intravenously or orally) was a pain score of 7 or above, patient age 50–64 years and suspected fractured neck of femur. Reduction in pain score of 2 or more points was significant whatever the initial pain score and associated with age 50–84 years. There was no association between use of strong opiate analgesic or reduction in pain score and sex of patient and/or sex of paramedic or crew member. Conclusion Our initial analysis showed a high level of non-recording of pain scores. There was no association between use of strong opiate analgesics or reduction in pain score of 2 points or more with patient sex or crew sex or paramedic skill level.

Responding to Diversity and Delivering Equality in Prehospital Care: Statutory Responsibilities, Best Practice and Recommendations

Population and workforce diversity in the National Health Service (NHS) together with legislation and national guidance has led to equality becoming an increasingly important issue for patients, service users and staff. Ambulance services, as public sector organisations, are bound by The Equality Act 2010 and as NHS organisations are actively encouraged to implement the Equality Delivery System (EDS) and its successor EDS2, providing the local strategic context to understand and address system inequalities. This chapter examines current challenges for ambulance services in relation to equality and why this matters. It goes on to explore how services are responding to diversity, how they should embed this through engagement with both patients and staff and how they should understand the effects of these activities through more effective data monitoring.