More to be done (as ever) on the interventions that matter, and those that don't. And how we improve access for those that need it most.

Thanks to good colleagues who helped to bring the paper together and support from @scotambservice.bsky.social

For what it's worth, adding into recent @drmikechristian.bsky.social, Lavery et al. meta-analysis in @sjtrem.bsky.social, via letter from @adamboulton17.bsky.social

Consistent effects of PHCC.

sjtrem.biomedcentral.com/articles/10....

No significant difference in functional outcomes. We've been fortunate to have access to these through great work from the registry - so often difficult to assess what likely matters most to patients with these methods.

emj.bmj.com/content/earl...

There's good news here, that those reaching critical care experience little harm from their isolation

Though even in Scotland, a place with a mature rural healthcare system & well-developed critical care transfer, a gap may remain in critical care provision to the most isolated

The work benefits from travel time mapping, giving a more accurate reflection of access to critical care.

Amongst the limitations are that exact routes to hospital care are unknown.

On a personal note, it's been an enormous project to get this out, and I'm hugely grateful to the co-authors. Paper available at journals.sagepub.com/doi/10.1177/...

Also demonstrates clear differences in ICU requirement across socioeconomic spectrum - almost 3x more ICU admissions for least deprived.

Adds to evidence of Inverse Care Law in emergency and critical care - resource does not match need.

Limitations in this type of work (see the paper), but really vital we get this part of the system right.

The efficacy of the model is secure, probably now time to focus on how best to find the patients that benefit, what works on-scene, and how we maximise the efficiency

As an aside, a real demonstration of the kind support that's sometimes-forgotten in academia. @drmikechristian.bsky.social encouraged the re-analysis, which strengthens original results.

Grateful for the support to do this work, and maybe some small hope this might reach those with policy levers to support these important interventions.

But fundamentally, this programme appears to benefit patients and health systems. We need to seriously consider how we embed similar programmes across emergency care, with access across time-of-day, and day-of-week. Requires funding and will.