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1. Red cell haemolysis secondary to intraosseous (IO) blood transfusion in adult patients with major trauma: a systematic review

Author

Matt Ellington, I Walker, E Barnard, Ellington, Matt [0000-0003-4176-9345], and Apollo - University of Cambridge Repository

Subjects
blood bank & transfusion medicine, accident & emergency medicine, trauma management, General Medicine
Abstract

IntroductionIntraosseous (IO) administration of medications and blood products is accepted practice in major trauma when intravenous access is not immediately available. However, there is a concern that the high infusion pressures required for IO transfusion may increase the risk of red cell haemolysis and its associated complications. The aim of this systematic review is to synthesise the existing evidence describing the risks of red cell haemolysis in IO blood transfusion.MethodsWe undertook a systematic search of MEDLINE, CINAHL and EMBASE using the search terms: “intraosseous transfusion” and “haemolysis”. Two authors independently screened abstracts, and reviewed full-text articles against the inclusion criteria. Reference lists of included studies were reviewed and a grey literature search undertaken. Studies were assessed for risk of bias. Inclusion criteria were: all human and animal study types that reported novel data on IO-associated red cell haemolysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used.ResultsTwenty-three abstracts were identified; n=9 full papers met the inclusion criteria. No further studies were identified from reference lists or grey literature. These papers included: seven large animal translational studies, a prospective and a retrospective human study. The overall risk of bias was high. One animal study with good translatability to adult patients with trauma demonstrated haemolysis. Other animal studies had methodological constraints that limit their human applicability. No haemolysis was observed in low-density flat bones (sternum), whereas haemolysis was reported in long bones (humerus, tibia). IO infusion using a three-way tap was associated with haemolysis. Conversely, pressure bag transfusion was not associated with haemolysis, but this method may result in insufficient flow rates for effective resuscitation.ConclusionsThere is a paucity of high-quality evidence surrounding the risks of red cell haemolysis in IO blood transfusion. However, evidence from one study suggests that the likelihood is increased by use of a three-way tap to administer blood transfusion to young adult male patients with trauma. Further research is needed to address this important clinical question.PROSPERO registration numberCRD42022318902.

Published
2023
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2. Protocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia

Author

P.M. Odor, S. Bampoe, D.N. Lucas, S.R. Moonesinghe, J. Andrade, J.J. Pandit, Alicja A'Court, Dina Abdel-Gadir, Ayman Abdu, Caroline Abisogun, Zainab Aboud, Judith Abrams, Andrea Ackerman, Christine Adamso, Rachel Addison, Adedayo Adeyeye, Rachel Adler, Maame Aduse-Poku, Siddharth Adyanthaya, Najmiah Ahmad, Dabeeruddeen Ahmed, Atif Ahmed, Bucky Akindele, Olubukola Akindele, Sonia Akrimi, Samar Al-Rawi, Yousif Ali, Jo Allam, Alisha Allana, Kellie Allen, Orlanda Allen, Natasha Amaradasa, Lareina Amarasekara, Freda Amoakwa-adu, Padmanabhan Anandageetha, Suresh Anandakrishnan, Rathai Anandanadesan, Michelle Anderson, Simon Apps, Audrey Aquilina, Gill Arbane, Alice Arch, Sarah Armstrong, Rita Arya, Gloria Ashiru, Keri Ashpole, Claire Atkinson, Francesca Atkinson, Elizabeth Auer, Ben Avery, Maite Babio-Galan, Hareth Bader, George Badham, Subha Bagchi, Sarah Bailey, Yolanda Baird, Cristina Balaka, Melissa Baldwin, Paul Balfour, Shreya Bali, Samantha Banks, Philip Barclay, Lucy Barnes, Thomas Barnes, Niraj Barot, Stephen Barrett, Venetia Barrett, Kate Barrett, Louise Bates, Katherine Batte, Beki Baytug, Mona Behravesh, Suzanne Bell, Raul Benloch, Richard Bentley, Jennifer Berg, Charlotte Berwick, Richard Berwick, Rashmi Bhadange, Sanjoy Bhattacharyya, Egidija Bielskute, Sian Birch, Scott Bird, Ruth Bird, William Birts, Becky Black, Tatyana Blagova, Holly Blake, Oliver Blightman, Susara Blunden, Richard Bolton, Caroline Borkett-Jones, John Boselli, Manuella Bowen, Ruth Bowen, James Bowye, Henry Boyle, Zameen Brar, Jo Bray, Samantha Brayshaw, Catherine Bressington, Alison Brewer, Naomi Brice, Laura Bridge, James Briscoe, Sonia Brocklesby, Harry Brown, Sarah Brown, Derek Brunnen, Keshavareddy Burijintichenna, Sara Burnard, Agnieszka Burtt, Victoria Buswell, Hannah Bykar, Matthew Cairney, Clare Calvert, Laura Camarasa, Natasha Campbell, Frederick Campbell-Jones, Jane Cantliffe, William Carrol, Joanna Carvalho, Catherine Cashell, Sarah Cassie, Kadu Cassim, Marika Chandler, Rachel Chapman, Robert Charles, Ping Chen, Deanne Cheyne, Kiran Chima, Floju Chin, Radu Chirvasuta, Martin Shao Chong, Sadia Choudhury, Priyakam Chowdhury, Tracey Christmas, Shilpa Chughwani, Sarah Ciechanowicz, Emma Clarey, Rob Coe, Jolyon Cohen, Nicholas Coker, Karen Collins, Lauren Collis, Jasna Comar, Marianne Conroy, Kathy Constantin, Jeremy Corfe, Elaine Coulborn, Vanessa Cowie, Rachel Crone, James Cronin, Jennifer Crooks, Nicola Crowther, Elizabeth Crowther, Carina Cruz, Alexa Curtis, Sarah Curtis, Sam Curtis, Adrian Dabrowicz, Nick Daines, Viral Dalal, Peter Dannatt, Dinesh Das, Jennifer Dash, Katherine Davidson, Sarah Davies, Yvette Davis, James Dawson, Jonathan Dean, Caroline Dean, Jane Denman, Neel Desai, Preeti Dewan, Sarah Dimont, Clare Donovan, Mano Doraiswami, Kate Doughty, Jamie Douglass, Michelle Dower, Samantha Downing, Wendy Duberry, Emily Duckham, Lucy Dudgeon, Stephanie Dukes, Leigh Dunn, Venkat Duraiswamy, Anthony O' Dwyer, Kristyn Dyer, Suresh Eapen, Mark Earl, Sally Eason, Kylie-Ellen Edwards, Zara Edwards, Osinachi Egole, John Ekpa, Olivia El-Amin, Kariem El-Boghdadly, Okba Elbasir, James Eldridge, Laura Elgie, Matt Ellington, Katharine Elliott, Justine Elliott, Mohamed Elmi, Ramy Elnoumeir, Eunice Emeakaraoha, Matt Evans, Mary Everett, Philippa Fabb, Hadia Farooq, Rohan Farrimond, Fiona Faulds, Erik Fawcett, Andrew Feneley, Dinushi Fernando, Janis Ferns, Claire Finlay, Simon Fitzgerald, Doireann O'Flaherty, Mark Fleet, Lydia Fletcher, Vanessa Fludder, Terri Follet, Jane Forbes, Mark Forth, Greg Foster, John Francis, Kate Fraser, Lauren Friedman, Luca Fruggeri, Laura Fulton, Sam Funnell, Amit Gadre, Ajay Gandhi, Harriet Gardiner, Zoe Garner, Gráinne Garvey, Tom Gately, Richard George, Siobhan Gillespie, Stephanie Glover, Jennifer Goddard, Ben Goodman, Tarikere Gopal, George Graham, David Green, Denise Griffin, Jessica Griffith, Stephanie Grigsby, Julie Grindey, Huw Griffiths, Jonathan Groome, Christine Grother, Gabrielle Grounds, Alice Groves, Abhik Guha, Amila Gunawardhana, Aman Gupta, Rekha Gupta, James Gutsell, Richard Haddon, Dina Hadi, Nicola Hadjipavlou, Henry Hammerbeck, Laura Hammon, Sarah Hammond, Hampesh Hampanna, Holly Hancock, Hemantha Handapangoda, Yumna Haroon-Mowahed, Dawn Harpham, Grant Harris, Abigail Harrison, Divya Harshan, Andrew Hartopp, Eoin Harty, Nick Haslam, Gemma Hawkins, Edith Hawkins, Sarah Hawksey, Carole Hays, Tracy Hazelton, Andrew Heavyside, Chibuzo Hemeson, Katrina Henderson, Oliver Henry, Lara Herbert, Nikki Higgins, James Hilton, Claire Hindmoor, Rachael Hitchcock, Laura Hobbs, Michele Homsy, Cassandra Honeywell, Nazima Hoque, Kirsty House, Ryan Howle, Amanda Tiller, Matthew Huniak, Jeremy Hunte, Tauqeer Husain, Coralie Huson, Catriona Hussain, Tawhida Hussain, Zainab Hussein, Jeremy Hyams, Eleanor Hyde, Marina Iaverdino, Alex Ignacka, Erin Innes, Stefanos Ioannidis, Rehana Iqbal, Fahja Ismail, Jenny Jackson, Michael Jackson, Guy Jackson, Robyn Jacobs, Poonam Jadhav, Aisha Jalaly, Lorraine James, Monica James, Surekha Jani, Chandran Jeganathan, Claire Joannides, Robert Johnson, Thosa Johnson, Carolyn Johnston, Reeanne Jones, Tom Jones, Miran Kadr, Rasmeet Kainth, Jenna Kane, Rafiq Kanji, Sunil Kannanparambil, Girish Kar, Theanalli Kasianandan, Husam Kaskos, Lisa Kavanagh, Richard Kaye, Leith Kelliher, Serena Kelliot, Jemma Kelly, Jenna Kelly, Carol Kenyon, Laura Kessack, Samuel Kestner, Mohammed Khaku, Sophia Khaleeq, Pervaz Khan, Sabeen Khan, Usamah Kidwai, Christopher King, Helen King, Elizabeth Kingston, Waisun Kok, Rebekka Konig, Zheyna Konstantinova, Priya Krishnan, Justin Kua, Kavitha Kuntumalla, Emira Kursumovic, Krzysztof Kurzatkowski, Hariprasad Kuttambakam, Katherine Lane, Sophie Lane, Andrew Langton, Hamad Latif, Norlan Lau, Shyam Laxman, Helen Laycock, Rachel Lee, Silvia Leonardi, Karen Light, Heidi Lightfoot, Shuang Liu, Sanduni Liyanage, Jessica Lowe, Nuala Lucas, Miyoba Lungu, Marianne Lunn, Heather Lynes, Kishore Machavarapu, Matthew Mackenzie, Jonathan Major, Victoria Male, Zain Malik, Katarina Manso, Myrna Maquinana, Katarzyna Marciniak, Lizzie Maronge, Chris Marsh, Carmela Martella, Nicki Martin, Nicole Martins, Jaspreet Marway, Louisa Mason, Lucy Mason, Nadia Masood, James Masters, Matthew Maton-Howarth, Francesca Mazzola, Tamsin McAllister, Rachel McCarthy, Claire McCormick, Sharon McCready, Steffan McDougall, Lorna Mcewan, Jon McGarry, Helen McKevitt, Stephanie Mckinley, Anna Mckskeane, Eloise McMaster, Martina McMonagle, Helen McNamara, Hannah McPhee, Laura McRae, Dee Mead, Emma Meadows, Madhur Mehta, Joanne Meikle, Yavor Metodiev, Chloe Michael, Victoria Millar, Sarah Miller, Gregg Miller, Sezanne Milne, Kostas Miltsios, Lucia Misquita, Simone Misquita, Manasi Mittal, Mohamed Mohamed, Katherine Powell Monaghan, Joanna Monk, Alexandra Monkhouse, David Monks, Laura Montague, Angela Moon, Jennifer Moran, Annette Moreton, Endaf Morgan, Oliver Morgan, Danny Morland, Monica Morosan, Kimberley Morris, Andrea Morris, Clare Moser, Manulella Mount, Carol Muir, McDonald Mupudzi, Mayur Murali, Iona Murdoch, Heather Murray, Theresa Murray, Karen Murrell, Girish Narasimha Murthy, Diana Neeley, Hannah Nei, Kerry Neil, Tara Nejim, Mark Nel, Anne Nicholson, Angela Nicklin, Catherine Nolan, Tracey Nolan, Eveliina Nurmi, Bridie O'Neill, Christie Oakes, Neil Oakes, Maria Ochoa-Ferraro, Nike Odeleye, Katy Oliver, Mark Oliver, Julie Onslow, Desire Onwochei, Thomas Oommen, Tim Orr, Osato Osagie, Hannah Osborn, Jennie Overend, Hazel Owston, Emma Pack, Pulak Padhi, Prabvathy Palani, Rajesh Pandey, Dhruti Pandya, Navjot Panesar, Con Papageorgiou, Georgios Papanastasiou, Costas Papoutsos, Suji Pararajasingham, James Parry, Hasita Patel, Jaishel Patel, Jiten Patel, Kaumudi Patel, Kiran Patel, Mitul Patel, Reshma Patel, Ruchira Patel, Nimisha Patel, Sangeeta Pathak, Fiona Pearson, Viktorija Peciulene, Beth Peers, Benjamin Peirce, Stacey Pepper, Jasmina Perinpanayagam, Hollie Perry, Nadya Petrova, Trudie Phillips, Sioned Phillips, Leonidas Phylactides, Felicity Pilkington, James Plumb, Evangelia Poimenidi, Anna Sau Kuk Poon, Thomas Potter, Una Poultney, Lucy Powell, Andrew Prenter, Katie Preston, Anna Price, Naomi Pritchard, Jenny Pullen, Manishi Purohit, Charlotte Quamina, Jibran Qureshi, Zahra Rajput, Stephen Ramage, Tamilselvi Ramanathan, Upeka Ranasinghe, Kalum Ranatunga, Abby Rand, Seema Randive, Desikan Rangarajan, Chandana Rao, Sambasiva Rao Pelluri, Antony Ratnasingham, Jamil Razzaque, Anuvidya Reddy, Katie Redington, Emma Reel, Peter Remeta, Francesca Ricco, Anna Riccoboni, Polly Rice, Mel Rich, Nicole Richards, Joanne Riches, Simon Ripoll, Fleur Roberts, Kitty Roberts, Kay Robins, Susie Robinson, Samantha Roche, Maria Rojo, Milena Carmela Romano, Hilary Rosser, Lindsay Roughley, Catriona Routley, Christine Rowley, Pallab Rudra, Robin Russell, Christine Ryan, Chloe Saad, Abtin Sadeghi, Armorel Salberg, Matt Samuel, Rebecca Samuels, Suresh Sanapala, Seliat Sanusi, Sarbpreet Sarao, Sathyabhama Sathyabhama, Zoe Saunders, Bernadetta Sawarzynska-ryszka, Panagiota Sceales, Penny Sceales, Natasha Schumacher, Nuala Schwartz, Claudia Sellers, Heather Sellers, Jessica Sellick, Soumen Sen, Dhaneesha Senaratne, Sarah Senbeto, Dineth Seneviratna, Thunga Setty, Raj Shah, Sonia Shah, James Shambly, Saju Sharafudeen. Imran Sharieff, Laurence Sharifi, Lisa Sharpe, Michael Shaw, Ian Sheldrake, Priya Shinde, Adam Shonfeld. Jonathon Short, Julian Siah, Sheena Sibug. Omar Siddique, Sara Siew, Matthew Simpson, Georgina Singleton, Kathryn Sinha, Aneeta Sinha, Matthew Sinnott, Harry Sivadhas, Sivanth Sivakumar, Boopathi Sivarajan, Sinduja Sivarajan, Chris Skeoch, Samuel Slade, Paul Slater, Camilla Smith, Carys Smith, Christopher Smith, James Smith, Lorraine Smith, Annika Smith, Edward Smith, Ruth Smith, Sue Smith, Tim Smith, Helen Smithers, Sue Smolen, Claire Smyth, Toni Snel, Carol Snipe, Sam Soltanifar, Nilesh Sonawane, Andal Soundararaja, Emily Spence, Mark Spiliopoulos, Chhavi Srivastava, Karen Stacey, Helena Stafford, Nikki Staines, Richard Stead, Emma Stevens, Alex Stilwell, Gary Stocks, Aaron Stokes, Christopher Stone, Ben Straughan, Vanitha Subbarathnam, Srinath Sudunagunta, Pervez Sultan, Puvan Suppiah, Priyanka Surve, Angus Sutherland, Rob Swanton, Claire Swarbrick, Amy Swinson, Eleni Syrrakou, Shahrzad Tadbiri, Preetam Tamhane, Perumal Tamilselvan, Andrew Tan, Shamil Tanna, Hayley Tarft, Laura Tarry, Ian Taylor, Suzanne Taylor, Julie Tebbot, Svetlana Theron, Megan Thomas, Sarah Todd, Hermione Tolliday, Charlotte Topham, Nicholas Tovell, Martyn Traves, Dawn Trodd, Aseem Tufchi, Katie Turley, Marc Turnbull, Chris Turnbull, Oliver Turner, William Turner, Sharon Turney, Eleanor Tyagi, David Uncles, Vanessa Unsworth, Pradnya Vadnere, Rama Varadan, Vik Vasishta, Andrew Veal, Lalitha Vedham, Jessica Venkaya, Miriam Verghese, Icel Veronica, Dinesh Vidanagamage, Rachel Vincent, Vinodhan Vyapury, Harris Wain, Fiona Walbridge, Elaine Walker, Pete Walsh, Eleanor Walshe, Michelle Walters, Yize Wan, Cherry Wang, Kavita Wankhade, Gareth Waters, Christopher Watts, Alex Webber, Tom Wedgwood, Michael Wee, Susan Wellstead, Alison White, Michael Whitear, Lucy Whitefield, Sarah Wilkinson, Lauren Williams, Rhys Williams, Dawn Wilson, Samantha Wilson, Katie Wimble, Elaine Winkley, Luke Winslow, Paul Winwright, Karolina Wloch, Gideon Wong, Hannah Wong, Jan Man Wong, Tim Wood, Sarah Wray, Ian Wrench, James Wu, Kynn Wynn, Yeng Yap, Chia Kuan Yeow, Emily Young, Alex Yusaf, Saeed Uz Zafar, Darius Zeinali, Sheldon Zhang, Sarvesh Zope, Liana Zucco, Sibtain Anwar, Nadia Blunt, John Cronin, Vimal Grover, Kate Grailey, Martin Grey, David Highton, Phil Hopkins, Harriet Kemp, Queenie Lo, Daniel Martin, Clare Morkane, James O'Carroll, Charles Oliver, Benjamin Post, Anil Visram, and Alex Wickham

Subjects
Adult, One year follow up, Trial protocol, Guidelines as Topic, Anesthesia, General, Intraoperative Awareness, Cohort Studies, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Anesthesia, Obstetrical, Humans, Medicine, General anaesthesia, Prospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, medicine.disease, United Kingdom, Anesthesiology and Pain Medicine, Accidental, Cohort, Structured interview, Female, Medical emergency, business, Surgical patients, Cohort study
Abstract

Background Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research was designed to address practical and methodological challenges for investigating AAGA in an obstetric cohort. Methods This is the trial protocol of a prospective, multicentre cohort study of patients undergoing obstetric surgery under general anaesthesia. Accidental awareness during general anaesthesia will be detected using three repetitions of standardised direct questioning over 30 days, with responses indicating memories during general anaesthesia verified using structured interviews. Reports will be adjudicated, then classified, in accordance with pre-defined and pre-validated structures, including the Michigan Awareness Classification tool. Quantitative data will be collected on general anaesthesia conduct for all participants. This descriptive study is being conducted in England and aims to recruit a minimum of 2015 patients. Results The DREAMY study was prospectively registered (ClinicalTrials.gov Identifier: NCT03100396) and ethical approval granted. Participant recruitment began in May 2017 and one year follow up concluded in August 2019. Publication of the results is anticipated in 2020. Conclusions The DREAMY study will provide data on incidence, experience and implications of AAGA for obstetric patients, using a robust methodology that will reliably detect and translate subjective AAGA reports into objective outcomes. In addition, the study is expected to improve vigilance for AAGA in participating hospitals and encourage adoption of recommendations for support of patients experiencing AAGA.

Published
2020
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3. Procedural sedation at role 1: applicability to military clinicians and minimum monitoring criteria

Author

R J Booker and Matt Ellington

Subjects
Sedation, Conscious Sedation, Primary health care, Guidelines as Topic, Officer, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Airway Management, Military Medicine, North Atlantic Treaty, Monitoring, Physiologic, Medical treatment, business.industry, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Triage, Military Personnel, Reduced consciousness, Medical emergency, medicine.symptom, business, First aid
Abstract

Procedural sedation is defined as producing a state of reduced consciousness, where the patient is still able to respond to verbal or physical stimulus and to continuously maintain a patent airway and adequate ventilation. This can be done to facilitate treatment that would not be otherwise possible. Recent evidence, guidelines and new equipment introductions have improved the safety of procedural sedation at UK role 1 medical treatment facilities (MTFs). A role 1 MTF is defined by the North Atlantic Treaty Organization as a medical facility focusing on the provision of primary healthcare, specialised first aid, triage, resuscitation and stabilisation, and is usually staffed by a general practitioner or a general duties medical officer. This paper aims to update role 1 clinicians on the current evidence base and guidance regarding monitoring of patients during procedural sedation.

Published
2020
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4. Safe Return to Play Following ACL Reconstruction in Young Athletes

Author

Zachary Stinson, Jennifer Beck, Aristides Cruz, Matt Ellington, Curtis VandenBerg, Sasha Carsen, Stephanie Mayer, and Allison Crepeau

Abstract

In order to reduce the risk of a second ACL injury following primary ACL reconstruction in young athletes, return to play (RTP) strategies are implemented that utilize temporal, psychological, and functional benchmarks. This strategy should be discussed with patients and their social support group prior to surgery in order to set proper expectations. Physiologically, time is needed for both graft maturation and incorporation as well as neuromuscular recovery. To monitor readiness for return to sport, validated measurement tools should be utilized along with functional assessments to address neuromuscular deficiencies. Patient reported outcome measures and psychological readiness should also be taken into account when assessing athletes’ readiness to return to play. As athletes transition back to sport, ACL injury prevention training programs should be implemented on an ongoing basis. There remains insufficient evidence to support the routine use of functional ACL bracing to prevent ACL re-injury.

Published
2020
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5. Clinical predictors of specialist treatment requirements in pelvic fracture: A retrospective cohort study

Author

Matt Ellington, Louise Trent, Alexandra Caulfield, and William L Hamilton

Subjects
030222 orthopedics, education.field_of_study, medicine.medical_specialty, business.industry, Population, 030208 emergency & critical care medicine, Retrospective cohort study, Critical Care and Intensive Care Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Intensive care, District hospital, Emergency medicine, Emergency Medicine, medicine, Pelvic fracture, Surgery, education, business
Abstract

Objectives and background To describe the pelvic fracture population presenting to a district hospital in New Zealand and investigate whether clinical measurements can predict subsequent transfer to specialist tertiary care units. Early transfer to tertiary care is associated with improved surgical outcomes and cost-effectiveness, but there has as yet been little research into predictive markers for referral. Methods Retrospective cohort study of all patients admitted with pelvic fracture to the intensive care unit of Hastings Memorial Hospital, New Zealand from 2005 to 2014. The primary outcome was transfer to specialist tertiary care. Secondary outcomes were total duration of hospitalisation and conservative vs. surgical management. Clinical variables including age, sex, observations and comorbidities were analysed against these outcomes using logistic regression. Results Data from 40 patients were collected (24 male, 16 female; median age: 44 years). Median distance from the hospital was 22.6 km, with 27 (67.5%) patients transported by land and 13 (32.5%) arriving by helicopter. Median time from receipt of emergency call to arrival at hospital was 60 min. Three patients died and 14/40 (35%) required transfer to tertiary centres. Damage to intra-abdominal structures such as spleen, liver and bladder lacerations were associated with transfer to tertiary care, unadjusted relative risk 3.34 (95% confidence intervals: 1.39–8.05). Conclusion Despite a 10-year recruitment window, only 40 patients were included in this study, limiting its statistical power. Nonetheless, our data suggest that pelvic fracture patients with injuries to intra-abdominal viscera are more likely to require tertiary care transfer.

Published
2017
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6. Are battlefield and prehospital trauma scenarios an effective educational tool to teach leadership and crisis resource management skills to undergraduate medical students?

Author

Matt Ellington and S Farrukh

Subjects
Emergency Medical Services, Students, Medical, 020205 medical informatics, Situation awareness, 02 engineering and technology, Crisis resource management, Resource Allocation, 03 medical and health sciences, 0302 clinical medicine, Resource (project management), Battlefield, Rating scale, Trauma management, 0202 electrical engineering, electronic engineering, information engineering, Humans, 030212 general & internal medicine, Prospective Studies, Medical education, Civil Defense, General Medicine, United Kingdom, Leadership, Observational study, Communication skills, Psychology, Education, Medical, Undergraduate
Abstract

IntroductionLeadership and crisis resource management (CRM) skills are important skills for doctors, however there is a recognised lack of undergraduate leadership education. There remains debate over how best to teach leadership and CRM skills, and poor leadership skills among clinicians are associated with adverse patient outcomes. We examined whether high-fidelity battlefield and prehospital scenarios can improve leadership and CRM skills.MethodThis was a prospective observational study with students self-reporting their leadership and CRM skills using the Ottawa Crisis Resource Management Global Ranking Scale (OCRMGRS) before and after completing the Cambridge University Emergency Medicine Society Battlefield and Pre-Hospital Trauma course. The course involves a mixture of small group tutorials and practical high-fidelity battlefield and prehospital trauma scenarios. Faculty also completed the OCRMGRS for the first and last candidates at the scenarios. The mean precourse versus mean postcourse score of the OCRMGRS was analysed using a two-tailed t-test.Results46 students completed paired OCRMGRS before and after the course. The mean precourse scores for each of the domains (leadership, communication skills, resource utilisation, problem solving skills and situational awareness) were calculated. There was a statistically significant (pConclusionsLeadership and CRM skills are important non-clinical skills for doctors, however there is debate over how best to teach them. High-fidelity battlefield and prehospital trauma scenarios are an effective means of teaching leadership and CRM skills to civilian medical students.

Published
2018

7. Reducing Time to First on Scene: An Ambulance-Community First Responder Scheme

Author

Alan Campbell, Matt Ellington, and Apollo - University of Cambridge Repository

Subjects
Technology education, Article Subject, 4 Quality Education, education, Crew, Poison control, 32 Biomedical and Clinical Sciences, Suicide prevention, Occupational safety and health, 03 medical and health sciences, First responder, 0302 clinical medicine, Clinical Research, Injury prevention, Medicine, 030212 general & internal medicine, 3202 Clinical Sciences, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Human factors and ergonomics, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Health Services, medicine.disease, Emergency Medicine, Medical emergency, business, Research Article
Abstract

The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the “First Person on Scene” Business and Technology Education Council (BTEC) qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs), alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min). The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students.

Published
2016

8. Undergraduate medical education; a new role for Army Reserve Medical Units?

Author

N Chilvers and Matt Ellington

Subjects
Medical education, Restructuring, business.industry, General Medicine, United Kingdom, Medical services, Clinical Physiology, Military Personnel, Trauma management, Medical training, Medicine, Humans, business, Military Medicine, Education, Medical, Undergraduate
Abstract

Amid transition and restructuring within Army Medical Services and the FR2020 policy,[1][1] keeping reservists’ skills up to date promises to be an ongoing challenge. There is also a current paucity in undergraduate medical training of acutely unwell patients.[2][2] The 254 Medical Regiment have

Published
2014

9. Resuscitating two birds with one stone: Improving ambulance response times and enhancing medical student education of the acutely unwell patient

Author

Alan Campbell and Matt Ellington

Subjects
Male, medicine.medical_specialty, Emergency Medical Services, Students, Medical, Ambulances, Emergency Nursing, Time-to-Treatment, Nursing, Medicine, Humans, Retrospective Studies, business.industry, Emergency Medical Service Communication Systems, Student education, Quality Improvement, Survival Analysis, Cardiopulmonary Resuscitation, United Kingdom, Heart Arrest, Family medicine, Emergency Medicine, Female, Cardiology and Cardiovascular Medicine, business, Education, Medical, Undergraduate, Program Evaluation
Published
2014

10. An unusual case of abdominal sepsis following traumatic injury

Author

Matt Ellington

Subjects
Adult, medicine.medical_specialty, Abdominal pain, Colon, Colonoscopy, Rectum, Article, Sepsis, Young Adult, Crohn Disease, Ileum, Animals, Humans, Medicine, Horses, Colitis, Inflammation, medicine.diagnostic_test, business.industry, Anti-Inflammatory Agents, Non-Steroidal, Transverse colon, Sigmoidoscopy, General Medicine, Inflammatory Bowel Diseases, medicine.disease, digestive system diseases, Abdominal Pain, Surgery, medicine.anatomical_structure, Wounds and Injuries, Accidental Falls, Female, medicine.symptom, Gastrointestinal Hemorrhage, business, Low Back Pain, Rare disease
Abstract

A 19-year-old woman presented to our emergency department with crampy abdominal pain and per rectal bleeding 2 weeks after falling from a horse. She had been taking regular non-steroidal anti-inflammatory drugs (NSAIDs) for analgaesia. On arrival, she was tachycardic and tachypnoeic, with a lactate of 7.3 mmol/L. 'FAST' ultrasonography was unremarkable and CT scan showed thickened wall of the transverse colon. She underwent flexible sigmoidoscopy, which demonstrated "patchy inflammation and an isolated area of severe deep ulceration with nodularity and oedema". A presumptive diagnosis of "Inflammatory Bowel Disease-likely Crohn's", was made, and treated accordingly with steroids and Pentasa. Two months following discharge, the patient underwent a colonoscopy, showing a normal colon, however, "a few ulcers in the terminal ileum" were seen. She was seen by a gastroenterologist who deemed the most likely diagnosis to be NSAID-induced terminal ileitis and colitis. Having stopped the offending NSAID (and steroids), she has now made a full recovery.

Published
2015
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11. Investigation into the Genetic Diversity of Panton-Valentine Leukocidin (PVL) positive Staphylococcus aureus isolates from North London using Spa Typing and Toxin Profiling

Author

Laura Shallcross, Matt Ellington, Angela M. Kearns, Susan Hopkins, and Kerry Williams

Subjects
Microbiology (medical), Genetic diversity, Infectious Diseases, Toxin, Staphylococcus aureus, medicine, Biology, Panton–Valentine leukocidin, Spa typing, medicine.disease_cause, Virology, Microbiology
Published
2011
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