Can ambulance telephone triage using NHS Pathways accurately identify paediatric cardiac arrest?

BACKGROUND: Most out-of-hospital paediatric cardiac arrests (CA) are not identified until a call is made to the emergency medical services. Accurate identification increases overall survival by enabling immediate ambulance dispatch and delivery of bystander CPR. European ambulance services use a variety of didactic telephone scripts to interrogate the caller and rapidly identify paediatric CA. The performance of these scripts has not been reported. This study aims to evaluate the diagnostic accuracy of the NHS Pathways as a telephone triage tool to identify patients less than 16 years age in cardiac arrest. METHODS: All emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by 'NHS Pathways' v9.04 were identified. All actual or presumed paediatric CAs (<16 years age) identified by the emergency call taker were cross-referenced with the ambulance crew's Patient Report Form to identify all confirmed CAs. RESULTS: Over a 12-month period from March 2015, a total of 540,715 emergency calls were received by SCAS, of which 53,213 related to children, 2052 (3.86%) being categorised by 'NHS Pathways' as paediatric CA. On arrival of the ambulance crew, only 87/2052 (4.24%) patients were in CA. Sensitivity=71.3%; specificity=96.3%; positive predictive value=4.2%. NHS Pathways missed the CA in 28.7% cases. CONCLUSIONS: This is the first reported evaluation of any currently used European paediatric telephone triage system for identifying CA. Further work is required to refine telephone triage pathways for paediatric cardiac arrest.

Ambulance telephone triage using 'NHS Pathways' to identify adult cardiac arrest.

BACKGROUND: UK ambulance services are called to 30 000 cardiac arrests (CAs) annually where resuscitation is attempted. Correct identification by the ambulance service trebles survival by facilitating bystander-cardiopulmonary resuscitation (CPR) and immediate ambulance dispatch. Identification of CA by telephone is challenging and involves algorithms to identify key features. 'NHS Pathways' is now used for triage by six of 12 UK ambulance services, covering a population of 20 million. With the significant improvements in survival when CA is accurately identified, it is vital that 'NHS Pathways' is able to identify CA correctly. METHODS: All '999' emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by NHS Pathways v9.04 were identified. All actual or presumed CAs identified by the emergency call taker were cross-referenced with the ambulance crew's Patient Report Form to identify all confirmed CAs. RESULTS: A total of 469 400 emergency (999) calls were received by SCAS. Of the 3119 CA identified by ambulance crew, 753 were not initially classified as CA by NHS Pathways (24.1%). Overall, sensitivity=0.759 (95% CI 0.743 to 0.773); specificity=0.986 (95% CI 0.9858 to 0.98647); and positive predictive value=26.80% (95% CI 25.88 to 27.73%). CONCLUSIONS: NHS Pathways accurately identifies 75.9% of adult CAs. The remainder represents approximately 7500 treatable CAs in the UK annually where the diagnosis is missed, with significant implications for patient outcome. Further work is required to improve this first link in the chain of survival.

Bactericidal activity of the human skin fatty acid cis-6-hexadecanoic acid on Staphylococcus aureus.

Human skin fatty acids are a potent aspect of our innate defenses, giving surface protection against potentially invasive organisms. They provide an important parameter in determining the ecology of the skin microflora, and alterations can lead to increased colonization by pathogens such as Staphylococcus aureus. Harnessing skin fatty acids may also give a new avenue of exploration in the generation of control measures against drug-resistant organisms. Despite their importance, the mechanism(s) whereby skin fatty acids kill bacteria has remained largely elusive. Here, we describe an analysis of the bactericidal effects of the major human skin fatty acid cis-6-hexadecenoic acid (C6H) on the human commensal and pathogen S. aureus. Several C6H concentration-dependent mechanisms were found. At high concentrations, C6H swiftly kills cells associated with a general loss of membrane integrity. However, C6H still kills at lower concentrations, acting through disruption of the proton motive force, an increase in membrane fluidity, and its effects on electron transfer. The design of analogues with altered bactericidal effects has begun to determine the structural constraints on activity and paves the way for the rational design of new antistaphylococcal agents.

Smarter running can keep buildings fit.

Simon England, director at Accenture Health UK, outlines the benefits of an "assessment-based" approach to creating "smarter" healthcare buildings with reduced running costs and a lower carbon footprint.

Base of coracoid process fracture with acromioclavicular dislocation in a child.

Fracture of the coracoid process is a rare injury. It can be easily missed when associated with other injuries to the shoulder girdle, for instance, acromioclavicular joint (ACJ) dislocation. Clinical attention is easily drawn to the more obvious ACJ dislocation, hence, the need for further radiological evaluation. We report an unusual case of fracture of the base of coracoid process associated with a true acromioclavicular joint dislocation in a 12 year old boy, with no separation of the epiphyseal plate, as one might expect. Treatment also remains controversial. Our patient underwent open reduction internal fixation of the acromioclavicular joint and coracoid process. He subsequently made an uneventful progress with pain free full range of shoulder movement at 5 months, and was discharged at 9 months.

Retrograde popliteal approach to common femoral vein stenosis in an intravenous drug user with hostile groin: a case report.

Intravenous (IV) drug abuse is a common problem in our society. One complication of this practice is venous stenosis, endovascular management of which can be technically challenging especially in patients with a hostile groin. We describe an ipsilateral retrograde popliteal approach in a 26-year-old IV drug user presenting with swelling of the left leg secondary to common femoral vein stenosis. This approach represents the next best method following failed contralateral/cross-bifurcation access and is a safe, convenient alternative offering a "straight run" at the lesion.

Muscular metastasis, a rare presentation of non-small-cell lung cancer.

A 71-year-old man presented with a 2-week history of pain and swelling of his left arm. Subsequent investigations revealed an intramuscular lesion, suggestive of soft tissue sarcoma. Histologic analysis was surprisingly consistent with metastasis from a primary squamous cell lung cancer. Skeletal muscle metastasis as a mode of presentation of primary lung cancer is an unusual phenomenon. A brief literature review accompanies this report.