WP5 Unscheduled and Emergency (including pre-hospital) Care

This work package focuses on appropriate (‘Prudent’) emergency and unscheduled care, avoiding unnecessary contacts and streamlining the emergency care system. We build on established collaborations with UK-wide ambulance services to develop and test alternative care models, linking closely to the e-trials methodological theme, (2016-18), and continue our close connection with the 999 EMS Research Forum to disseminate research and transfer knowledge to practice (2016-18).

Core activities

  • Increase the quantity of large scale high quality research carried out in or led from Wales
  • Achieve high and demonstrable research impact
  • Undertake research and dissemination activities that are of key importance to patients and the public
  • Build capacity for research in primary and emergency care in Wales, across disciplines, sectors, professional groups and levels of seniority.


Professor Helen Snooks, Swansea University

Current projects

  1. ERA - Electronic Records in Ambulances to support the shift to out of hospital care
  2. Evaluation support for NHS 111 Integrated Urgent Care Workforce Development Programme
  3. ExPLAIN - Exploring factors increasing paramedic likelihood of administering analgesia in pre-hospital pain
  4. NEAT - Network exploring Ethics of Ambulance Trials
  5. PAPHiF - Pilot Study to validate a clinical tool to aid paramedics in their diagnosis of hip fracture
  6. PHED Data - Data Linkage across Ambulance Services and Acute Trusts: Assessing the Potential for Improving Patient Care
  7. RAPID - Rapid Analgesia for Prehospital Hip Disruption
  8. TIER - Transient Ischaemic Attack 999 Emergency Referral
  9. Using record linkage analysis to inform the development of an improved care pathway(s) for psychiatric and self-harm emergencies currently transferred by ambulance to EDs


Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial. Snooks HA, Anthony R, Chatters R, Dale J, Fothergill RT, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons RA, Mason S, Nicholl J, Peconi J, Phillips C, Porter A, Siriwardena AN, Wani M, Watkins A, Wilson L2, Russell IT. Ann Emerg Med. 2017 Mar 13. pii: S0196-0644(17)30016-1. doi: 10.1016/j.annemergmed.2017.01.006. [Epub ahead of print]

Referral pathways for patients with TIA avoiding hospital admission: a scoping review. Evans BA, Ali K, Bulger J, Ford GA, Jones M, Moore C, Porter A, Pryce AD, Quinn T, Seagrove AC, Snooks H, Whitman S, Rees N, on behalf of the TIER Trial Research Management Group. BMJ Open 2017;7:e013443. doi:10.1136/bmjopen-2016-013443

Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial. J Bulger, A Brown, BA Evans, GW Fegan, S Ford, K Guy, L Keen, I Pallister, N Rees, D Russell, IT Russell, AC Seagrove, HA Snooks. Pilot and Feasibility Studies 2017 3:8 DOI: 10.1186/s40814-016-0115-6

How do emergency ambulance paramedics view the care they provide to people who self harm?: Ways and means. N Rees, F Rapport, H Snooks, A John, C Patel. Int J Law Psychiatry. 2017 Jan - Feb;50:61-67. doi: 10.1016/j.ijlp.2016.05.010. 

Involving older people in a multi centre randomised trial of a complex intervention in prehospital emergency care: implementation of a collaborative model. Koniotou M, Evans BA, Chatters R, Fothergill R, Garnsworthy C, Gaze S, Halter M, Mason S, Peconi J, Porter A, Siriwardena AN, Toghill A, Snooks H.Trials 16:298 doi: 10.1186/s13063-015-0821

It could be a ‘Golden Goose’: a qualitative study of views in primary care on an emergency admission risk prediction tool prior to implementation. A Porter, MR Kingston, BA Evans, H Hutchings, S Whitman, H Snooks. BMC Family Practice 201617:1. DOI: 10.1186/s12975-015-0398-3

The national community pharmacy NHS influenza vaccination service in Wales: a mixed methods study. Evans AE, Wood F, Carter B. Br J Gen Pract 2016; 66 (645): e248-e257. DOI:

Emergency Care. Helen Snooks. J.Health serv Res Policy July 2016 vol. 21 No. 3 188-194. doi: 10.1177/1355819616644177

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. Flynn D, Francis R, Robalino S, Lally J, Snooks H, Rodgers H, McClelland G, Ford G, Price C. BMC Emerg Med. 2016; 17: 5. 

Costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol. Kingston M, Evans BA, Nelson K, Hutchings H, Russell I, Snooks H. BMJ Open 2016;6:e009653 doi:10.1136/bmjopen-2015-009653 https://doi.org/10.3399/bjgp16X684349

All Wales Injury Surveillance System revised: development of a population based system to evaluate single and multi-level interventions. Lyons R, Turner S, Lyons J, Walters AM, Snooks H, Greenacre J, Humphreys C, Jones S. Inj Prev 2016;22:i50-i55 doi:10.1136/injuryprev-2015-041814

Non-accidental non-fatal poisonings attended by emergency ambulance crews: an observational study of data sources and epidemiology. John A, Okolie C, Porter A, Moore C, Thomas G, Whitfield R, Oretti R, Snooks H. BMJ Open. 2016 Aug 18;6(8):e011049. doi: 10.1136/bmjopen-2016-011049.

Support and Assessment for Fall Emergency Referrals (SAFER) 2: Cluster randomised trial and systematic review of clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer older people to community based care following a fall. Snooks, Helen. Health Technology Assessment, 2016.

Community based interventions to prevent fatal overdose from illegal drugs: a systematic review protocol. Okolie C, Evans BA, John A, Moore C, Russell D, Snooks H. BMJ Open 2015;5:e008981

Perceptions of paramedic and emergency care workers of those who self harm: a systematic review of the quantitative literature. Rees N, Rapport F, Thomas G, John A, Snooks H. J Psychosom Res. 2014 Dec;77(6):449-56. doi: 10.1016/j.jpsychores.2014.09.006.