Doctorate Title: An exploration of the recognition of deterioration in ems witnessed cardiac arrest: improving national outcomes from out-of-hospital cardiac arrest (OHCA).

The thesis is centred around the premise that despite the presence of globally agreed evidence-based treatment guidelines, there exists significant variation in the recognition of patient deterioration in the pre-hospital environment by Emergency Medical Services (EMS). The synthesis of my body of work will demonstrate and evidence the steps taken to address this deficit in knowledge. Here, I synthesise the findings from my public outputs and abstracts from 2015 to 2022 (acknowledging my frontline clinical responsibilities during Covid-19 and personal illness), and also acknowledging my contribution to a major textbook publication. This will demonstrate the contribution these outputs have made to improving the identification of deterioration, thereby reducing variation in the survival of patients suffering EMS witnessed out-of-hospital cardiac arrest (OHCA) in Scotland. I extracted key findings from these papers, analysed their contribution, and examined the links made to demonstrate their influence on national guidelines and policy development into one progressive and coherent body of work, to demonstrate the overall impact on patient outcomes for the people of Scotland and beyond. Summarising these into five key themes, I have synthesised my portfolio as a clinical academic spanning over twenty years alongside over thirty years of clinical practice in frontline paramedicine, adding depth and breadth to this thesis. An exploration of the Recognition of Deterioration in EMS-witnessed cardiac arrest: Improving national outcomes from out-of-hospital cardiac arrest (OHCA). Five key themes were constructed – starting with identifying a 4-fold variation in global outcomes from EMS-witnessed OHCA. Secondly, my work supports the acceptability and feasibility of measuring pre-hospital vital signs as a mechanism to detect deterioration. Thirdly, adaptation of early warning vital signs scores can standardise measurement between pre-hospital and in-hospital outcomes; this has created a common language and understanding of deterioration across the whole patient journey. Fourth, that the establishment of a national pre-hospital early warning scoring system is the baseline that provides the ability to standardise medical care and measure improvements. Next with evidence presented, I have continued the golden thread by showcasing work – using intubation and clinical video as exemplars – that has demonstrably changed practice at a regional and national level, thus making the bridge between research and practice in a relatively short space of time and at scale. Collectively, incorporating these themes has enabled my work to inform pre-hospital care, making sustained and impactful changes across the national EMS system in Scotland, resulting in evidence of improvement of survival over a ten-year period. It demonstrates this contribution to the body of knowledge as an exploration of the Recognition of Deterioration in EMS-witnessed cardiac arrest which has also contributed to Improving national outcomes from Out-of-hospital cardiac arrest (OHCA).

End Date: 2026

Status: Complete