The development and critique of validated assessment tools for pre-hospital resuscitation skills

Purpose The purpose of this paper is to describe the development of clinically credible skill practice and assessment guides for intraosseous (IO) needle insertion and laryngeal mask airway (LMA) insertion as two essential components of advanced life support (ALS) training. Design/methodology/approach A modified Delphi approach was used to determine expert consensus in the application of IO and LMA devices for the pre-hospital and emergency setting. Nine pre-hospital clinical specialists were recruited to participate in this Delphi study to determine consensus of clinical expert practice. Findings Two rounds were required to obtain a performance and assessment checklist for each skill. Both lists were then further modified to maximise their useability. However, the development of a “validated” checklist using a pre-determined process such as a Delphi approach is challenged. Rather, the implementation of these tools in a stated context, and analysis of the data they generate, is an essential aspect of validation which the Delphi approach does not address. Research limitations/implications Participant feedback regarding the rationale for their scores was limited in this study in order to minimise participant input and maximise completion of all rounds of the study. Further, devices used in the study may no longer be first-line choices with the advent of more modern devices including semi-automatic IO devices and LMAs which do not have inflatable cuffs. The refined checklists are able to be adapted to these newer devices. Practical implications Pre-hospital education contexts which may not have access to expert assessors who are skilled in providing global judgements now have access to clinically relevant skill-specific assessment tools for IO and LMA insertion. Originality/value Worldwide, ALS accreditation and competence is demanded of countless health professionals, and to date, validated practice and assessment guides specifically developed for the emergency setting for which they are used, are not available in the published literature. This paper proposes to fill that gap, in addition to guiding clinical education researchers in strategies to develop valid assessment tools through rigorous critique.

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PP25 The take home naloxone intervention multicentre emergency setting feasibility (TIME) trial: an early perspective from one UK ambulance service

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.25 ◽

2021 ◽

Vol 38 (9) ◽

pp. A11.1-A11

Author(s):

Sasha Johnston ◽

Helen Snooks ◽

Jenna Jones ◽

Fiona Bell ◽

Jonathan Benger ◽

...

Keyword(s):

Life Support ◽

Controlled Trial ◽

Advanced Life Support ◽

Time Trial ◽

Ambulance Service ◽

Feasibility Trial ◽

Royal Infirmary ◽

Emergency Setting ◽

Training Time ◽

Randomised Controlled

BackgroundDrug poisoning deaths in England and Wales have increased by 52% since 2011 with over half involving opioids. Deaths are preventable if naloxone is administered in time. Take Home Naloxone (THN) kits have been distributed through drug services; however, uptake is low and effectiveness unproven. The TIME trial tests the feasibility of conducting a full randomised controlled trial of providing THN administration and basic life support training to high-risk opioid-users in emergency care settings.MethodsA multi-site feasibility trial commenced in June 2019 with two hospitals and their surrounding ambulance services (Bristol Royal Infirmary (BRI) with South Western Ambulance NHS Foundation Trust (SWASFT) and Hull Royal Infirmary with Yorkshire Ambulance Service) randomly allocated to intervention arms; and sites in Wrexham and Sheffield allocated as ‘usual care’ controls. SWASFT began recruiting in October 2019 with the aim of recruiting and training 50% (n=111) of paramedics working within the BRI’s catchment area, to supply THN to at least 100 eligible patients during a 12-month period.ResultsThe trial was suspended between 17.03.2020-06.08.2020 and extended to 01.03.2021 (COVID-19). Despite this, 121 SWASFT paramedics undertook TIME training. TIME trained paramedics attended 30% (n=57) of the n=190 opioid-related emergency calls requiring naloxone administration during the study period. A total of n=29 potentially eligible patients were identified before and n=28 after the COVID-19 suspension. Two patients were supplied with THN during each period. During the COVID-19 suspension, twenty-two potentially eligible patients were missed. The majority of eligible patients presented with a reduced consciousness level, preventing recruitment (73%; n=42/48). These patients were transported to hospital for further treatment (n=39) or died on scene following advanced life support (n=3).ConclusionsThe lowered consciousness levels of prehospital emergency ambulance patients who present with opioid poisoning, often prevent the delivery of training required to enable the supply of THN.

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Schizophrenia and “unmet needs”: From diagnosis to care in Italy

European Psychiatry ◽

10.1192/j.eurpsy.2019.8 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

Silvana Galderisi ◽

Marco A. Riva ◽

Paolo Girardi ◽

Mario Amore ◽

Bernardo Carpiniello ◽

...

Keyword(s):

Clinical Practice ◽

Delphi Study ◽

Unmet Needs ◽

Early Recognition ◽

Accurate Identification ◽

Integration Of Care ◽

Delphi Approach ◽

Essential Components ◽

Strong Consensus ◽

Barriers And Challenges

Abstract Background. Schizophrenia is a leading cause of disability. People living with schizophrenia (PLWS) present unemployment, social isolation, excess mortality and morbidity, and poor quality of life. Early recognition and appropriate treatment reduce the risk of chronicity and comorbidity. Personalization and integration of pharmacological and psychosocial interventions, as well as accurate identification and management of psychiatric and somatic comorbidities, can significantly improve mental and physical health of PLWS, promoting recovery. Methods. A three-step Delphi approach was used to explore consensus on the essential components of early recognition and intervention, personalization, and integration of care to improve schizophrenia outcome, and on barriers and challenges to close treatment gaps. The consensus involved 8 Italian experts of schizophrenia, 100 psychiatrists from academic and nonacademic settings, including representatives of Italian Society of Psychiatry, and 65 trainees in psychiatry. Results. A strong consensus (from mostly agree to totally agree) emerged on the importance of early diagnosis (97%), standardized assessments (91%), correct management of somatic and psychiatric comorbidities (99%), and personalization and integration of care (94%). Lack of time, human resources, and training were identified as the main barriers and challenges to the translation of knowledge into clinical practice. Conclusions. The results of this Delphi study demonstrated a strong consensus on main components of schizophrenia care, as well as on unmet needs to promote best practice and gaps between knowledge and clinical practice. The involvement of a large group of professionals and trainees in this in-depth consensus process might contribute to raise awareness and stimulate innovative strategies to improve the outcome of PLWS.

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The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Southern African Journal of Critical Care ◽

10.7196/sajcc.2016.v32i2.275 ◽

2016 ◽

Vol 32 (2) ◽

pp. 58 ◽

Cited By ~ 1

Author(s):

Monique Venter ◽

Willem Stassen

Keyword(s):

Critical Care ◽

Delphi Study ◽

Life Support ◽

Advanced Life Support ◽

Scope Of Practice

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Qualitative Delphi approach of advanced algae biofuels

Management of Environmental Quality An International Journal ◽

10.1108/meq-03-2014-0046 ◽

2015 ◽

Vol 26 (6) ◽

pp. 852-871 ◽

Cited By ~ 3

Author(s):

Lauro Andre Ribeiro ◽

Patricia Pereira da Silva

Keyword(s):

Delphi Method ◽

Delphi Study ◽

Design Methodology ◽

Theoretical Work ◽

Content Type ◽

Technical Data ◽

Algae Biofuels ◽

Expert Opinions ◽

Delphi Approach ◽

Source Of Information

Purpose – Currently, experimental and theoretical work is being performed to ensure that biofuels from microalgae become a reality. However, there is a considerable number of discussions concerning in which processes should be focussed efforts of research and development. The purpose of this paper is to provide decision support not only to help build guidelines of research to be undertaken, but also to contribute to the design of more adequate policy and funding instruments. The key objective of this study is to determine the prospects of employing microalgae into the production of biofuels within a time scale extending to 2030. Design/methodology/approach – The Delphi method is a qualitative research aiming to support strategic future-oriented action, such as policy making in the areas of science and technology. It is especially appropriate in judgment and long-range forecasting (20-30 years) situations, when expert opinions are often the only source of information available, due to a lack of appropriate historical, economic or technical data. Findings – The Delphi method proved to be a successful research method when expert opinions are the main source of information available, due to a lack of appropriate historical, economic or technical data and the outcomes provided a clear outline of the main issues of microalgae biofuels’ market at present and in the future. Research limitations/implications – The outcomes might not represent the majority of the microalgae experts’ opinion due to the sample size. Originality/value – The work presented in this paper is especially original. According to the authors’ knowledge, this is the first qualitative Delphi study related to algae biofuels.

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Standards for Resuscitation After Cardiac Surgery

Critical Care Nurse ◽

10.4037/ccn2015652 ◽

2015 ◽

Vol 35 (2) ◽

pp. 30-38 ◽

Cited By ~ 5

Author(s):

S. Jill Ley

Keyword(s):

United States ◽

Cardiac Arrest ◽

Cardiac Surgery ◽

Heart Surgery ◽

Life Support ◽

Survival Rates ◽

Advanced Life Support ◽

The United States ◽

High Survival ◽

Essential Components

Of the 250 000 patients who undergo major cardiac operations in the United States annually, 0.7% to 2.9% will experience a postoperative cardiac arrest. Although Advanced Cardiac Life Support (ACLS) is the standard approach to management of cardiac arrest in the United States, it has significant limitations in these patients. The European Resuscitation Council (ERC) has endorsed a new guideline specific to resuscitation after cardiac surgery that advises important, evidence-based deviations from ACLS and is under consideration in the United States. The ACLS and ERC recommendations for resuscitation of these patients are contrasted on the basis of the essential components of care. Key to this approach is the rapid elimination of reversible causes of arrest, followed by either defibrillation or pacing (as appropriate) before external cardiac compressions that can damage the sternotomy, cautious use of epinephrine owing to potential rebound hypertension, and prompt resternotomy (within 5 minutes) to promote optimal cerebral perfusion with internal massage, if prior interventions are unsuccessful. These techniques are relatively simple, reproducible, and easily mastered in Cardiac Surgical Unit–Advanced Life Support courses. Resuscitation of patients after heart surgery presents a unique opportunity to achieve high survival rates with key modifications to ACLS that warrant adoption in the United States.

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The development of neonatal nursing standards of practice for Cambodia: a Delphi study

Journal of Health Research ◽

10.1108/jhr-11-2017-002 ◽

2018 ◽

Vol 32 (1) ◽

pp. 12-23 ◽

Cited By ~ 1

Author(s):

Manila Prak ◽

Suvinee Wivatvanit

Keyword(s):

Nursing Care ◽

Delphi Study ◽

Content Type ◽

Children Under Five ◽

Under Five ◽

Neonatal Nursing ◽

Standards Of Practice ◽

Delphi Approach ◽

Nursing Standards ◽

E Mail

Purpose Cambodia has one of the highest death rates for children under five years of age in Southeast Asia. The high mortality rate of children under five years of age, especially the neonate is 35 per 1,000 for the period zero to four years. There are no neonatal nursing standards of practice to guide nurses providing neonatal nursing care. Some general guidelines are currently being implemented for both doctors and nurses. The Minister for Health officially launched the Cambodian Council of Nurses’ Guideline for the Standard of Nursing Care in December 2015. In the absence of specific neonatal nursing standards of practice, the purpose of this paper is to develop the Neonatal Nursing Standard of Practice for Cambodia. Design/methodology/approach The Delphi technique was selected as being appropriate for this study. The snowball with purposive sampling was used. The identified experts were located across Cambodia so the e-Delphi approach was considered appropriate and applicable according to the study context. Four experts preferred to be interviewed face-to-face, while 16 experts were confident to use e-mail to respond to the questionnaire in Round 1. In total, 19 experts provided responses via e-mail to the Rounds 2 and 3 questionnaires. Findings A Standard for Neonatal Nursing Practice for Cambodia which consists of ten standards was found as a result of this study: assessment, nursing diagnosis, planning, implementation, evaluation, ethics, evidence-based practice and research, health teaching and health promotion, continuing education, and communication. Originality/value All items and sub-items achieved consensus as either being at the most significant level and therefore, could be key indicators for neonatal nursing standards of practice. The results of this study can be incorporated into a focused discussion led by the Nursing and Midwifery Bureau of the Ministry of Health to develop national standards of practice for neonatal nurses in Cambodia.

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Assessment Tools for Use During Anesthesia-Centric Pediatric Advanced Life Support Training and Evaluation

The American Journal of the Medical Sciences ◽

10.1016/j.amjms.2016.09.013 ◽

2017 ◽

Vol 353 (6) ◽

pp. 516-522 ◽

Cited By ~ 3

Author(s):

Scott C. Watkins ◽

Paul J. Nietert ◽

Elisabeth Hughes ◽

Eric T. Stickles ◽

Tracy E. Wester ◽

...

Keyword(s):

Life Support ◽

Advanced Life Support ◽

Assessment Tools

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Nonpharmacological Interventions for Pain Management in Paramedicine and the Emergency Setting: A Review of the Literature

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/873039 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Sok Cheon Pak ◽

Peter S. Micalos ◽

Sonja J. Maria ◽

Bill Lord

Keyword(s):

Pain Management ◽

Emergency Medical Services ◽

Life Support ◽

Management Strategies ◽

Advanced Life Support ◽

Medical Services ◽

Emergency Setting ◽

Pharmacological Interventions ◽

Complementary And Alternative Therapies ◽

Emergency Medical

Paramedicine and the emergency medical services have been moving in the direction of advancing pharmaceutical intervention for the management of pain in both acute and chronic situations. This coincides with other areas of advanced life support and patient management strategies that have been well researched and continue to benefit from the increasing evidence. Even though paramedic practice is firmly focused on pharmacological interventions to alleviate pain, there is emerging evidence proposing a range of nonpharmacological options that can have an important role in pain management. This review highlights literature that suggests that paramedicine and emergency medical services should be considering the application of complementary and alternative therapies which can enhance current practice and reduce the use of pharmacological interventions.

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