David Fitzpatrick

Scottish Ambulance Service · Education and Professional Development Department

Background COVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow. There have been almost 15 million cases of COVID-19 in the UK. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. To support...

With a rise in personal protective equipment (PPE) use by all healthcare professionals (HCP) as a prime infection control strategy in the wake of the COVID-19 pandemic comes the potential increase in its misuse. Evidence suggests this failure to follow proper PPE protocol to prevent self-contamination and transmission can be attributed to both a la...

Background As well as patient impact, COVID-19 also considerably impacts on staff who have been required to make challenging patient care decisions in uncertain circumstances. This study investigated ambulance clinicians’ experiences and use of decision support strategies during the COVID-19 pandemic. Methods Forty-eight percent (16/33) of paramed...

Background Little is known about how patients with COVID-19 present to ambulance services or their outcomes. Between 1st March and 31st August 2020 we investigated individuals who called the Scottish Ambulance Service (SAS) with COVID-19 symptoms and those that were later tested COVID-19 positive. We analysed i) their demographic and clinical chara...

Background: Alcohol consumption places a significant burden on emergency services, including ambulance services, which often represent patients' first, and sometimes only, contact with health services. We aimed to (1) improve the assessment of this burden on ambulance services in Scotland using a low-cost and easy to implement algorithm to screen...

Background Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data...

Background Scotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally. Methods National registry-based retrospective cohort study using 2011–2016 data from...

Background People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental health and self-harm emergencies attended by ambulance services, and subsequent all-cause mortality, including deaths by suicide....

Background Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or...

Background: Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Improving the accuracy and quality of handover may reduce associated mortality and morbidity. Although the practice of handover between Ambulance and Emergency Department clinicians has received so...

Background: Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves...

Objectives (1) To compare the experiences of people who are affected by diabetes-related hypoglycaemia and either do or do not require an emergency attendance and (2) to measure the prevalence of impaired awareness of hypoglycaemia in patients who are attended by an ambulance service due to a severe hypoglycaemic event. Design A sequential mixed-m...

Background: The highest achievable survival rate following out-of-hospital cardiac arrest is unknown. Data from airports serving international destinations (international airports) provide the opportunity to evaluate the success of pre-hospital resuscitation in a relatively controlled but real-life environment. Methods: This retrospective cohort...

Abstract Background Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the f...

Background Severe hypoglycaemia is a serious condition and accounts for 0.6%–1.0% of all UK emergency ambulance calls per annum. Our previous qualitative research suggested that many Diabetes related hypoglycaemia patients attended by the ambulance service experienced impaired awareness of hypoglycaemia (IAH), a treatable condition which reduces pa...

Background Effective management of people who present to ambulance services with a psychiatric or self-harm emergency is essential to ensure positive outcomes. However very little is known about this vulnerable patient population. Therefore, this study aimed to investigate their demographic characteristics, care pathways, and clinical and service o...

The Challenge Every year the Scottish Ambulance Service (SAS) receives thousands of calls relating to self-harm or a psychiatric emergency. Most of these patients are taken to emergency departments (EDs) at hospitals. Surprisingly, until now no research had been done on what happened to patients after their ED attendance. In order to provide epidem...

Aim To investigate the prevalence of Impaired Awareness of Hypoglycaemia in patients who require ambulance service attendance due to severe hypoglycaemia. Methods We undertook a national cross-sectional survey of the prevalence of Impaired Awareness of Hypoglycaemia (IAH). An a priori target sample size of 415 was set to allow estimation of propor...

Aim To investigate the effect of prehospital critical care team attendance, versus usual ambulance care, on trauma patient mortality. Methods We retrospectively examined data from the Scottish Trauma Audit Group for the calendar years 2011–14, covering all trauma patients admitted to hospital in Scotland. We divided them into two groups: those who...

Aim To investigate the demographic characteristics, care pathways, and clinical and service outcomes of people who present to ambulance services with a psychiatric or self-harm emergency Methods We conducted a retrospective cohort study of patients attended by the Scottish Ambulance Service in 2011 with ambulance clinician attendance codes relatin...

Introduction People categorised as having a psychiatric emergency or self-harm episode account for thousands of Scottish Ambulance Service (SAS) emergency calls every year. Most are conveyed to emergency departments (EDs). Anecdotally many are highly vulnerable, at increased risk of suicide and repeat ED attendance, but previously no data were ava...

INTRODUCTION Increasingly, ambulance services offer alternatives to transfer to the emergency department (ED), when this is better for patients. The introduction of electronic health records (EHR) in ambulance services is encouraged by national policy across the United Kingdom (UK) but roll-out has been variable and complex. Electronic Records in A...

This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called ‘Exodus Damnation’. The patient’s presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy a...

Background The Scottish Ambulance Service introduced paramedic practitioners in 2004 to reduce unnecessary hospital admissions. Development of the role has varied across the UK but little is known about this professional group within Scotland. Aims To describe paramedic practitioners views on their scope of practice and identify areas for improvem...

Hypoglycaemia is a common and potentially life threatening consequence of insulin and sulphonylurea treated Diabetes. Some severe hypoglycaemic events result in emergency ambulance attendance. Many of these patients are treated at home and do not require immediate transportation to an Emergency Department. However only 27-37 % of patients then foll...

Background In Scotland approximately 70% of patients with diabetes treated for a hypoglycaemic event by ambulance clinicians remain at home after treatment. However, many of these individuals experience repeat or subsequent hypoglycaemic events. Current clinical guidance recommends that individuals are advised to follow-up care with their GP, howev...

The University of Aberdeen MIME project (Managing Information in Medical Emergencies) aimed to develop technology to support volunteer rural community first responders when managing patients. This can be a particularly stressful activity with many challenges to overcome while waiting for ambulance clinicians to arrive. The MIME system employed ligh...

The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (...

Background: Community First Responders (CFR) are volunteers who respond to appropriate medical emergencies while an ambulance is en route. The emergencies that CFRs attend are situations where stress is inherent, yet little is known of which stressors and demands are present and which are considered to be the greatest attributer to stress experienc...

Background: Community First Responders (CFR) are volunteers who respond to appropriate medical emergencies while an ambulance is en route. The emergencies that CFRs attend are situations where stress is inherent, yet little is known of which stressors and demands are present and which are considered to be the greatest attributer to stress experienc...

Many hospitals struggle to implement the full sepsis care bundle, but research suggests that many patients with sepsis are transported to hospital by ambulance. In 2011, the Scottish Ambulance Service introduced a pre-hospital sepsis screening tool (PSST) to expedite sepsis identification and care delivery. However, ambulance clinicians have report...

Chronic obstructive pulmonary disease (COPD) is a long-term, incurable lung condition. Acute exacerbations are frequently encountered by ambulance clinicians and are routinely treated with oxygen therapy and nebulised drugs. Yet, delivering the appropriate amount of oxygen to these patients is challenging, and the effects of getting it wrong are si...

Chronic obstructive pulmonary disease (COPD) is a long-term, incurable lung condition. Acute exacerbations are frequently encountered by ambulance clinicians and are routinely treated with oxygen therapy and nebulised drugs. Yet, delivering the appropriate amount of oxygen to these patients is challenging, and the effects of getting it wrong are s...

Background The number, type; and complexity of equipment carried on frontline ambulances is increasing each year. While this enhances the range of prehospital interventions available, it also results in lengthy equipment checks which, on occasion, are interrupted by emergency calls. This can lead to ambulances arriving at an incident without vital...

Introduction In patients presenting with chest pain, the presence of Left Bundle Branch Block (LBBB) on the ECG may obscure the diagnosis of acute myocardial infarction (AMI). Patients with LBBB caused by AMI are shown to benefit significantly from rapid provision of reperfusion therapy, yet evidence suggests this is often underprovided. Difficulti...

Background The number, type; and complexity of equipment carried on frontline ambulances is increasing each year. Whilst this enhances the range of prehospital interventions available, it also results in lengthy equipment checks which, on occasion, are interrupted by emergency calls. This can lead to ambulances arriving at an incident without vital...

In patients presenting with chest pain, the presence of left bundle branch block (LBBB) on the electrocardiogram (ECG) may obscure the diagnosis of acute myocardial infarction (AMI). Patients with LBBB caused by AMI are shown to benefit significantly from rapid provision of reperfusion therapy, yet evidence suggests this is often underprovided. Dif...

Reperfusion options for patients suffering ST-elevation myocardial infarction (STEMI) have developed significantly over recent years and now include both thrombolytic therapy and primary percutaneous coronary intervention (PPCI). This system of care means that patients presenting with STEMI can be transferred directly to a heart-attack centre to re...

To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA) are at risk of repeat hypoglycaemic events (RHE) after being treated in the prehospital environment and whether they should be transported to hospital regardless of their post-treatment response, a systematic literature rev...

Ruptured abdominal aortic aneurysm (RAAA) classically presents with sudden onset, severe ripping or tearing abdominal pain radiating through to the back. This case report describes features of an atypical presentation of a patient with RAAA and highlights the difficulties and uncertainties surrounding the prehospital assessment, appropriate treatme...