Kacper Sumera

Background Prehospital pain management in children and young people (CYP) is a top research priority in paediatric emergency medicine. Approximately 90,000 CYP under 18 years of age are transported to hospital by ambulance each year for conditions associated with acute pain in England. Approximately half of the children suffering from acute pain do not receive analgesics from paramedics, and approximately 60% do not experience a meaningful reduction in their pain severity. The aim of these studies is to explore the experiences of key stakeholders, refine our programme theory, and prioritise candidate intervention components to address the gaps in care. Methods A realist evaluation using a multiple case study approach following the RAMESIS II guidance and consensus workshops using the modified nominal group technique will be performed. The realist evaluation will collect qualitative data (interviews, diaries, electronic messaging, arts-based materials) from CYP aged 4–17 years who have experienced acute pain and needed an ambulance in the previous 12 months, parents and carers, and ambulance clinicians. Recruitment will occur across England within three NHS ambulance services, two NHS children’s emergency departments, and via social media. We will also collect routine quantitative clinical record data from two NHS ambulance services. We will use a realist logic of analysis to code the data into conceptual buckets, develop context-mechanism-outcome configurations, and refine the programme theory developed from a previous realist review. Two consensus workshops will be held: one for CYP aged 7–17 years, parents and carers, public representatives, and members of the Young Persons Advisory Group, and one for ambulance clinicians, quality leads, and educators. Workshop attendees will review the study findings and candidate intervention components, vote on their importance, and review voting results. High-priority intervention components will be considered for incorporation into an intervention.

Background Prehospital pain management in children and young people (CYP) is a top research priority in paediatric emergency medicine. Approximately 90,000 CYP under 18 years of age are transported to hospital by ambulance each year for conditions associated with acute pain in England. Approximately half of the children suffering from acute pain do not receive analgesics from paramedics, and approximately 60% do not experience a meaningful reduction in their pain severity. The aim of these studies is to explore the experiences of key stakeholders, refine our programme theory, and prioritise candidate intervention components to address the gaps in care. Methods A realist evaluation using a multiple case study approach following the RAMESIS II guidance and consensus workshops using the modified nominal group technique will be performed. The realist evaluation will collect qualitative data (interviews, diaries, electronic messaging, arts-based materials) from CYP aged 4–17 years who have experienced acute pain and needed an ambulance in the previous 12 months, parents and carers, and ambulance clinicians. Recruitment will occur across England within three NHS ambulance services, two NHS children’s emergency departments, and via social media. We will also collect routine quantitative clinical record data from two NHS ambulance services. We will use a realist logic of analysis to code the data into conceptual buckets, develop context-mechanism-outcome configurations, and refine the programme theory developed from a previous realist review. Two consensus workshops will be held: one for CYP aged 8–17 years, parents and carers, public representatives, and members of the Young Persons Advisory Group, and one for ambulance clinicians, quality leads, and educators. Workshop attendees will review the study findings and candidate intervention components, vote on their importance, and review voting results. High-priority intervention components will be considered for incorporation into an intervention.

Background: Simulation-Based Education (SBE) is an essential component of paramedic training, offering a structured environment for students to develop clinical skills and decision-making capabilities. Despite the existence of SBE quality standards, such as those from the Association for Simulated Practice in Healthcare (ASPiH) and the International Nursing Association for Clinical Simulation and Learning (INACSL), the application of these standards in maintaining paramedic SBE quality remains inconsistent. This study explores paramedic educators’ perceptions of SBE quality, the challenges in applying SBE quality standards, and potential strategies for improvement. Methods: An exploratory qualitative research design was employed, utilising semi-structured interviews with eight paramedic educators from five higher education institutions in the East Midlands, UK. Data were analysed using template analysis to identify key themes related to maintaining paramedic SBE quality. Results: Participants were aware of the importance of quality in SBE, yet demonstrated limited awareness and inconsistent application of formal quality standards, often relying more on informal, experience-driven approaches. Psychological safety and student engagement were emphasised as crucial to effective SBE, yet institutional constraints, including financial limitations, staffing shortages, inadequate faculty training, hindered quality assurance efforts. There were also challenges in standardising simulation scenarios and debriefing practices, with educators highlighting the need for greater institutional support and structured training in simulation pedagogy. Conclusions: The study highlights significant opportunities to enhance the integration of quality standards in paramedic SBE, emphasising the need for improved faculty training, increased institutional investment, and structured quality assurance mechanisms. Addressing these barriers is essential to ensure consistency, effectiveness, and sustainability in paramedic SBE.

Introduction: It is common knowledge that the correct application of cardiopulmonary resuscitation (CPR) requires technical skills such as defibrillation, high‐quality chest compressions, and efficient airway management. However, scientific research is increasingly underlining the role of appropriate training in nontechnical skills (NTS). Research Aim: This exploratory study aimed to assess the relationship between NTS and the quality of advanced CPR among paramedics. Materials and Methods: The research involved 51 paramedics randomly assigned to 17 three‐person teams. Each team participated in a 15‐min cardiac arrest scenario. After the first session, the teams were divided into two groups: the intervention group (Group 1), which underwent specialized NTS training, and the control group (Group 2), which did not receive the initial training. Directly after the training phase, all teams from both groups carried out a second attempt during a simulated sudden cardiac arrest (SCA) scenario identical to the first one. Results: The lowest CPR result in the intervention group (Group 1) was Min = −3.00, and the highest Max = 13.00, while in the control group (Group 2), the lowest result was Min = −42.00, and the highest Max = 8.00 ( p < 0.05). In Group 1, a statistically significant correlation ( p < 0.05) was noted between the change in the NTS score and the change in the CPR result. A higher NTS score was accompanied by a higher CPR score. Conclusions: A short NTS training session was associated with improved NTS application by paramedic resuscitation teams. Furthermore, higher chest compression quality positively correlated with NTS proficiency.

Introduction: This study characterizes patients with abdominal and/or pelvic trauma admitted to Emergency Departments (EDs) in Poland, focusing on differentiating stable from unstable cases. The objective is to inform of evidence-based guidelines for managing these injuries in both critical and non-critical trauma patients. Aim: The study aims to characterize patients admitted to randomly selected Hospital Emergency Departments in Poland after abdominal and/or pelvic injury. It aims to provide evidence-based recommendations for managing abdominal and pelvic trauma. Materials and methods: A retrospective analysis was conducted using anonymized medical records from three randomly selected EDs in Poland, representing Levels I, II, and III of the Polish Trauma Care System. Patients with abdominal and/ or pelvic trauma were identified and categorised by trauma type, injury mechanism, severity, and stability. Data were summarized using descriptive statistics, and relationships between variables were analyzed using the Chi-square or Fisher’s exact test, with α = 0.05 for significance. Results: Of 93,714 ED patients, 708 met the study criteria, with 215 confirmed cases of abdominal and/or pelvic trauma. Closed (blunt) injuries were predominant (96.3%), especially low-energy injuries among older adults. Mild trauma was most common (64.65%) according to the CRAMS scale, while severe injuries accounted for only 8.84%. A substantial proportion of patients were stable upon ED admission, with 69.3% of abdominal trauma and 100% of pelvic trauma patients exhibiting no signs of organ failure or peritoneal symptoms. The findings indicate a higher-than-expected prevalence of stable trauma cases, underscoring the need for guidelines to manage stable but potentially vulnerable patients. Discussion: This study offers insights into the demographic and clinical characteristics of patients with abdominal and/or pelvic trauma in EDs, with a particular focus on differentiating stable from unstable trauma patients and addressing distinct clinical needs. By testing key hypotheses on trauma type, severity, and patient stability, the study brings attention to areas in trauma management that may benefit from revised protocols and resource allocation. Our findings underscore the importance of recognizing stable trauma patients as a significant but underrepresented group in trauma literature. Existing studies are often conducted in EDs located within trauma centres, which influences the patient populations represented in the literature. Additionally, a common inclusion criterion in such studies is trauma team activation or the explicit identification of unstable patients with systolic blood pressure below 90 mmHg. Research focusing on stable patients with abdominal and/ or pelvic trauma is rare and typically addresses aspects other than the specific characteristics of this group. However, in our study, a substantial proportion of patients with abdominal and/or pelvic trauma were clinically stable upon ED arrival. This has implications for ED triage, where prioritization often leans towards critically unstable cases, potentially overlooking the nuanced needs of stable patients who may still benefit from close monitoring to prevent deterioration. Conclusions: This study reveals a significant proportion of stable, low-severity abdominal and pelvic trauma cases in Polish EDs, challenging the traditional focus on high-risk, unstable trauma. Recognizing stable patients’ specific needs could optimize triage and resource allocation, reducing unnecessary admissions while maintaining quality care. Future guidelines should integrate protocols for stable trauma cases to improve ED efficiency and patient outcomes. Significance: The findings of this study underscore the need for optimized resource allocation within EDs. Given the high proportion of clinically stable, low-severity trauma cases, current triage protocols may require adaptation to ensure efficient patient management. The current study provides evidence supporting the refinement of trauma protocols, particularly for geriatric trauma patients, whose stable presentations can be misleading. Additionally, research suggests that dedicated monitoring processes for stable trauma patients could reduce preventable complications, particularly in cases involving lowenergy blunt trauma. Expanding on existing assessment tools, including modified early warning scores (MEWS) and geriatric trauma triage criteria, could help differentiate stable but at-risk patients from those who can be safely discharged.

Background Prehospital pain management in children and young people (CYP) is a top research priority in paediatric emergency medicine. Approximately 90,000 CYP under 18 years of age are transported to hospital by ambulance each year for conditions associated with acute pain in England. Approximately half of the children suffering from acute pain do not receive analgesics from paramedics, and approximately 60% do not experience a meaningful reduction in their pain severity. The aim of these studies is to explore the experiences of key stakeholders, refine our programme theory, and prioritise candidate intervention components to address the gaps in care. Methods A realist evaluation using a multiple case study approach following the RAMESIS II guidance and consensus workshops using the modified nominal group technique will be performed. The realist evaluation will collect qualitative data (interviews, diaries, electronic messaging, arts-based materials) from CYP aged 4 – 17 years who have experienced acute pain and needed an ambulance in the previous 12 months, parents and carers, and ambulance clinicians. Recruitment will occur across England within three NHS ambulance services, two NHS children’s emergency departments, and via social media. We will also collect routine quantitative clinical record data from two NHS ambulance services. We will use a realist logic of analysis to code the data into conceptual buckets, develop context-mechanism-outcome configurations, and refine the programme theory developed from a previous realist review. Two consensus workshops will be held: one for CYP aged 8-17 years, parents and carers, public representatives, and members of the Young Persons Advisory Group, and one for ambulance clinicians, quality leads, and educators. Workshop attendees will review the study findings and candidate intervention components, vote on their importance, and review voting results. High-priority intervention components will be considered for incorporation into an intervention.

Acute pain management in children and young people (CYP) attended by ambulance services is a significant challenge due to the complex nature of pain, the variation of approach needed across the age range, and the unpredictability of the environment. We aimed to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP. A realist review was conducted and reported in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. We developed an initial programme theory (PT) using key stakeholder input, searched the major bibliographic databases MEDLINE, CINAHL Complete and PsycINFO, and other sources from January 2000 to February 2024, screened and assessed relevance and rigour in duplicate, and performed synthesis and programme theory refinement. We developed an initial PT that focussed on the preparedness of staff and the expectations of CYP and parents/carers, along with key outcomes such as pain score severity, fear and anxiety. The subsequent search strategy yielded 1503 documents, of which 95 were included, representing empirical research articles, reviews, theses, book chapters and clinical guidelines. The initial PT was tested and refined throughout the synthesis to produce a PT underpinned by 34 context-mechanism-outcome configurations. The PT portrayed positive (e.g. presence of parents, focussed education and training, building trust) and negative (e.g. misinformation, fear and anxiety, long-term consequences) effects on prehospital acute pain management for CYP. This PT was mapped to the Behaviour Change Wheel to provide a clinically relevant behaviour change model for improvement. This realist review has provided a clinically focussed model to guide the improvement of prehospital acute pain management in children and young people attended by ambulance. The programme theory lays a foundation on which future empirical testing can be conducted to effect behaviour change in practice. Registration: CRD42024505978.

Background Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP. Methods A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual “buckets” using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual “buckets”, test and refine the IPT into a realist PT. Conclusion The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation. Registration PROSPERO Registration: CRD42024505978

Background Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP. Methods A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual “buckets” using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual “buckets”, test and refine the IPT into a realist PT. Conclusion The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation. Registration PROSPERO Registration: CRD42024505978

Background Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP. Methods A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT) – develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening – conduct a thorough search of relevant research databases and grey literature sources and perform screening in duplicate; 3) Document selection – assess documents for relevance and rigour in duplicate; 4) Extracting and organising data – code relevant data into conceptual “buckets” using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement – utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual “buckets”, test and refine the IPT into a realist PT. Conclusion The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation. Registration PROSPERO Registration: CRD42024505978