Doctorate
Doctorate Title: Recognition of deterioration in EMS-witnessed cardiac arrests : Improving national outcomes from Out-of-Hospital Cardiac Arrest (OHCA).
Doctorate Description: This aim of this PhD by public output is centred around the hypothesis that despite the presence of globally agreed evidence-based treatment guidelines, there exists significant variation in the recognition of patient deterioration in the pre-hospital environment by emergency medical services (EMS). This variation is associated with marked differences in patient outcomes, particularly mortality, but little is known about why these variations exists, or the best remedial strategies to reduce them. The synthesis of my body of work can help address this deficit in knowledge.
Contribution to knowledge
The contribution to knowledge of this PhD by public output begins in 2015 when, within a Scottish context, around 3,500 people were having resuscitation attempted each year after an OHCA in the community, and around 6% survived to hospital discharge. This was below the UK average of 10% and declining year on year. Approximately 30% of patients had a return of spontaneous circulation on arrival at hospital, with up to 6-fold variation in regional differences in incidence and survival outcomes.
This is in stark comparison to the reported best internationally in Seattle, USA with 62% survival and the State of Victoria, Australia with 31% survival. Notwithstanding the known challenges in interpreting the international reporting standards for OHCA - known as the Utstein template - there exists subtle differences in how countries quantify attempted resuscitation and exclude incidents from their denominator; the scale of the problem in Scotland was influenced by relevant factors such as size, population, a single healthcare system and a national ambulance service. Collectively these presented an opportunity for a national programme of work to be planned and implemented to improve OHCA care from 2015 to present, heavily informed by the applicant’s contribution within the body of work.
The golden thread that connects this work begins with the emerging science of pre-hospital practice, first with identifying key vital signs which influence patient care. The author then builds on this with clinical consensus and textbook outputs as well as empirical observational work, which then extends into publications on how deterioration is recognised in the ambulance setting, and how this impacts the quality of care. Drawing together these areas of literature, the author then focusses this knowledge on the implementation of a national programme of improvement for the most acutely unwell patients – those who suffer an OHCA. This golden thread shows pre-hospital science in its infancy, maturing into a sound literature base which formed the basis of the national initiative to improve OHCA survival rates. This has led to survival doubling from 1 in 20 in 2015 to 1 in 10 at its peak pre-covid. The proposed progressive portfolio of work will be presented to highlight the author’s major contributions to this body of work.
Details:
Type: PhD
University: Robert Gordon University
Primary Supervisor: Professor Catriona Kennedy
Category: Cardiac Arrest
Funding: University School
Start Date: 2024
End Date: 2025
Status: Ongoing
Thesis
Awaiting
Research Interests
Cardiac Arrest, Deterioration, Leadership
Publications
Survival from accidental strangulation from a scarf resulting in laryngeal rupture and carotid artery stenosis: the “Isadora Duncan syndrome”. A case report and review of literature
Resuscitation quality assurance for out-of-hospital cardiac arrest–Setting-up an ambulance defibrillator telemetry network
De técnico de transporte sanitario (TTS) a técnico de emergencias sanitarias (TES)(6): la experiencia en el Reino Unido
Issues around conducting prehospital research on out-of-hospital cardiac arrest: lessons from the TOPCAT study
011 EMS crews' attitudes towards working with pre-hospital doctors in the field
03 Temperature post out-of-hospital cardiac arrest: the TOPCAT study
EMS crews’ attitudes towards working with pre-hospital medical staff at out-of-hospital cardiac arrest scenes
Professional development of emergency medical responders from ambulance attendants to paramedics (6): experiences in the United Kingdom
Paramedic training programmes and scope of practice: A UK perspective
Capability of Scottish emergency departments to provide physician-based prehospital critical care teams: a national survey
Improving the quality of pre-hospital resuscitation through defibrillator feedback reporting and CPR training
Validation of the National Early Warning Score in the prehospital setting
How to implement live video recording in the clinical environment: A practical guide for clinical services
14 Initial prehospital vital signs to predict subsequent adverse hospital outcomes
Prehospital vital signs to predict 7-day mortality for patients transported to ed by emergency ambulance services: a cohort study
Consensus statement: a framework for safe and effective intubation by paramedics
03 Back to basics—ECG impedance analysis for CPR quality control and feedback after out-of-hospital cardiac arrest: a pilot study
Defining and recognising clinical deterioration in the prehospital setting (PRECLuDE study): a systematic scoping review
Prehospital Trauma Life Support
Global variation in the incidence and outcome of emergency medical services witnessed out-of-hospital cardiac arrest: A systematic review and meta-analysis
The COVID-19 ambulance response assessment (CARA) study: a national survey of ambulance service healthcare professionals’ preparedness and response to the COVID-19 pandemic
Can we define and recognise clinical deterioration in the prehospital setting? A systematic scoping review.
