Past CPD Modules

The challenges of managing paediatric pain

July 2009

Paediatric pain management is a complicated issue, and various barriers exist which prevent paediatric patients receiving optimal prehospital analgesia. These could be described as barriers attributable to the provider, the system, and the patient. This module will investigate each of the three barriers by examining current scholarly evidence, and conclude by suggesting solutions to begin overcoming the challenge of managing children in pain in the prehospital setting.

Patient handover

September 2009

This module discusses the concept of patient handover between ambulance clinicians and hospital staff, using a case study from the author’s practice. It looks both at handovers that take place in ‘resus’ rooms and those less time-critical exchanges in other areas of the Accident and Emergency Department. It explores how the handover can be rendered ineffective by errors in communication between the two parties and how this can be detrimental to the patient. It also looks into whether the hospital or ambulance staff are to blame for errors in patient handover. Finally, suggestions are made for areas of further study.

Survivability of prehospital cardiac arrest

December 2009

Prehospital cardiac arrest patients are historically known to have low survival rates. It is also a common medical presentation that ambulance clinicians have to treat. This survey looked at survivability figures of these patients brought into one hospital over a 12-month period, and discusses factors such as return of spontaneous circulation (ROSC), advanced life support (ALS) and basic life support (BLS). It also discusses the difficult choice of whether to ‘stay on scene’ or ‘load and go’.

Reading and reviewing academic articles

March 2010

This module will focus on accessing, reading and understanding academic journal articles. The ability to understand and use articles from journals is a fundamental
aspect of paramedic practice. Like any skill, the ability to read and interpret journal articles, improves the more you practise it. If you are not used to reading articles, or it is not part of your everyday practice, then it can appear pretty daunting in the first instance. This module aims to ‘demystify’ and address some of these fears and hopefully at the end of the module, readers will feel more confident to access, read and begin to make sense of the published literature.

Assessment of the acutely or seriously ill child or young person in the prehospital setting

April 2010

Children and young people (CYP) have distinctive needs within emergency and urgent care. Clinical
presentations can often be confusing with non-specific symptoms and numerous potential diagnoses
which may require a variety of assessment, management and treatment strategies. For the inexperienced practitioner, assessing CYP can be daunting. Applying clinical reasoning to these situations requires the practitioner to have an understanding of child-specific anatomy, physiology, pathophysiology and psychology; as well as the ability to consider other contributing factors such as the child’s ability to communicate.

Furthermore, it has been recommended that every professional who is involved in the care of a
child and/or young person, should, as a minimum, be competent in: recognition of the sick child; basic
lifesupport skills; initiation of treatment using protocols for the management of common conditions;
recognition of rare but treatable conditions; effective communication; recognition of and response to
any concerns about safeguarding and understanding the need for play and recreation activities.

In this article, a case presentation will be used to demonstrate how initial observations require
critical thinking in order to identify alternatives to the most obvious rationale for the presenting
signs and symptoms.

Understanding arrhythmias: paroxysmal supraventricular tachycardia in the prehospital setting

June 2010

Paroxysmal supraventricular tachycardia (PSVT) presents a challenging assessment to the prehospital emergency care provider. The nature of PSVT affects all age groups, has a range of aetiologies, is usually well tolerated but may also result in sudden cardiac arrest. It is able to be terminated by a range of therapies and is the subject of an evolving understanding of pathophysiology related to it. Therefore, it is essential that those providing prehospital care have an understanding of the nature and implications of PSVT in order to effectively manage this condition in the field. This module will use a systematic approach to highlight the pathophysiology, epidemiology, interventions, and issues, to arm the reader with the necessary knowledge to approach this patient with confidence.

Taking a patient history

August 2010

The aim of this module is to provide the reader with a detailed insight to taking a patient history, identifying some key issues and outlining the importance of documenting a patient history. Many paramedic and prehospital practitioners will already be documenting a patient history on a regular basis as an aspect of their everyday clinical practice. A patient report form (PRF), or similar documentation will guide the practitioner. Emergency care practitioners (ECPs) or paramedic practitioners (PPs) may also use a medical model to guide their comprehensive patient history, as outlined in this CPD module. However, for most paramedics and other prehospital or urgent care professionals, the practice of taking a comprehensive patient history is perhaps less familiar. This module will provide the reader with a background to the importance of tacking a patient’s medical history and also to consider developing and refining these skills. This module will also help to explain any patient history notes that you may have read as part of caring for a patient. This module is aimed largely at adult patients, although specific issues in relation to children are identified where appropriate.

Introduction to pharmacology

October 2010

Paramedics have often been considered, particularly by other urgent health professionals, at an advantage for having the ability to administer a wide range of therapeutic interventions. This ranges from the relatively innocuous aspirin to intravenous opiate analgesia, in the form of morphine. However pharmacology, or the study of drugs, is an area of the traditional paramedic training curriculum that has been lacking in recent years. This Continuing Professional Development (CPD) module aims to provide an introduction to some aspects of clinical pharmacology. Pharmacology touches on a number of other areas, such as mathematics, basic physics and chemistry and an awareness of the anatomy and physiology of some key organs, such as the kidney and liver. These particular subject areas may not necessarily appeal or be the most interesting to study and as such pharmacology can detract some individuals from further exploration of this fascinating aspect of clinical care. Pharmacology is really about a journey—the journey of a therapeutic intervention, or drug, from its humble inception in a laboratory test tube, through years of extensive and thorough research and development, to the marketing of a clinically effective drug that has the ability to literally save lives and stem the spread of illness and disease. This module will describe and outline the journey of the drug, from administration, describing the effect it has on the body, interactions, contraindications and how this impacts on clinical practice.

Dealing with the ‘difficult’ patient: strategies for practice

December 2010

This Continuing Professional Development (CPD) module will focus on the identification and management of the ‘difficult’ patient in prehospital care. ‘Difficult’ patients are an aspect of most health care professional’s (HCP’s) clinical lives. The management of such individuals can be challenging; causing stress to both the practitioner and those around them. The aim of this Module is to outline and identify some of the ‘difficult’ patients, and consider some management strategies and techniques on how these patients can be managed appropriately and safely. The module will also assist in managing your own feelings, by helping you to understand the rationale of some of the personality types.

Becoming a reflective practitioner: a framework for paramedics

January 2011

Reflective practice has gained the momentum of a runaway freight train among ambulance practitioners. The benefits of engaging in such an activity are now widely known and are recognized for playing a key role in professional development among prehospital professionals. Writing a reflective practice account for the first time can appear daunting and off-putting but with a little help and plenty of practice practitioners will be able to reap the benefits of reflective practice in no time at all. A variety of frameworks are available to guide the ambulance practitioner through this process and choosing the correct model of reflection could be argued as being the single most important first step when engaging in reflective practice. This module provides an opportunity to identify the origins of reflective practice and to explore the popular paradigm as it exists today. The ‘reflection’ activities will allow the user to gain experience undertaking a reflective account following one of the three profession-specific frameworks.

Recording 12-lead ECG's

February 2011

The British Heart Foundation estimates between 113 000—146 000 myocardial infarctions occur in the UK each year. Evidence shows that patients with ST elevation myocardial infarction (STEMI) require timely reperfusion therapy to improve survival (Keeley et al, 2007). Therefore, paramedics must be confident in their ability to record electrocardiograms (ECGs) quickly and accurately. Accurate ECGs are also crucial for identifying angina pectoris, malignant and non-malignant arrhythmias. This module aims to address some of the issues involved in recording a diagnostic quality ECG and highlights some pitfalls faced in the emergency prehospital setting.

Understanding the assessment and management of hyperkalaemic patients

March 2011

This module will explore the identification and treatment of hyperkalaemia in both the hospital and prehospital settings. Hyperkalaemia is potentially life-threatening and, by improving clinician’s awareness of the condition, paramedics should be able to positively impact upon patient outcome. Like many other life-threatening emergencies, prompt recognition and treatment is vital to reduce mortality and morbidity. By using reflective questions and establishing learning outcomes, the paramedic will achieve a foundation in the assessment and management of hyperkalaemic patients.

Cocaine toxicity: assessment and cardiac risk

April 2011

The UK has the highest prevalence of drug use within Europe, with a 13% increase in cocaine and ecstasy related deaths between 2004–2005. This is significant to emergency medical personnel as cocaine toxicity may present clinically as acute coronary syndrome (ACS) minus typical associated risk factors. Cocaine use has an immediate effect on the body within seconds to minutes of administration. The resultant effect is manifold and can be divided into the two broad categories of central nervous system (CNS) and cardiovascular. Cocaine has a strong association as a trigger of ACS, acute myocardial infarction (MI) and sudden death in a population of patients largely free of classic cardiovascular risk factors. This module will assist in understanding the effects of acute cocaine toxicity, recognizing electrocardiogram (ECG) changes and implementing an appropriate treatment plan.

Seizures in the prehospital setting

May 2011

Seizures are a common occurrence in the prehospital arena, however, with numerous conditions causing seizures prehospital clinicians can be left with a dilemma in the treatment of these patients. Patients who are actively seizing will predominately have their airway maintained, oxygen administered and therapeutic intervention (diazepam) initiated. One form of seizure, non-epileptic attack disorder or psychogenic seizures, are often called ‘pseudo’ seizures an acronym synonymous in the ambulance service, this gives connotations that the patient is ‘faking it’, however, these patients often have deep psychological trauma that needs careful handling and empathy.

Managing abdominal pain: a guide for paramedics

June 2011

Ambulance personnel encounter patients with abdominal pain on a weekly, if not daily basis. Despite this exposure, many of these patients continue to be managed without appropriate analgesia. Ambulance services remain focussed on trying to promote effective pain management, however this message still does not reach many clinicians. An understanding of pain mechanisms, assessment tools and subjectivity will aid the clinician in evaluating these patients, whilst a knowledge of current and possible future pain management strategies will assist when happening upon these service users.

Legal issues in paramedic practice

July 2011

This CPD module will focus on some of the key legal issues in relation to paramedic practice. Any text relating to medico-legal issues would of course not be complete without directing the reader to the vast range of excellent texts relating to medico-legal aspects in medicine and nursing, with a developing literature base in paramedic practice. This module will describe some of the core legal principles, specifically those of accountability and liability, that impact on paramedic practice. In addition, the module will also consider the issue of duty of care in prehospital practice and outline some key legal cases specifically in relation to the ambulance service. Law and ethics are often intertwined and rightly so. The legal cases presented in this module allow us to reflect on prehospital practice and critically review some of the professional and regulatory guidance that currently underpins paramedic practice. The second related module, on ethical issues, will further explore some of the issues in relation to paramedic practice.

Ethical issues in paramedic practice

August 2011

This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.

The pathophysiology of labyrinthitis

September 2011

Labyrinthitis is an inflammatory response within the membranous inner ear structures in response to infection. It is a generally short-lived minor illness that has the potential to cause temporary or permanent disablement in terms of hearing loss. Other symptoms include nausea and vomiting, pain in the affected ear, vertigo and fever. Subsequently, it is an illness commonly diagnosed by health practitioners working in the community setting. Understanding the pathophysiological development and the inflammatory and immune response to such an illness enables the clinician to comprehend the underlying processes of the presenting signs and symptoms, and to treat accordingly.

Risks and benefits of paramedic-initiated shoulder reduction

October 2011

A dislocated shoulder is a painful injury that requires early reduction to reduce pain and restore mobility. Anterior dislocations are the most common type, and techniques used to achieve reduction have a high rate of success and low rate of complications. While this procedure is commonly performed by physicians, a delay to care may be associated with unnecessary pain and complications associated with delayed reduction. As such, this module investigates the conditions under which paramedic management of these injuries may be appropriate.

Wound care in the prehospital setting

November 2011

This CPD module is aimed to provide an overall and generic approach to wound management, since it is not possible to provide a detailed approach for each type of wound that a paramedic may be presented with. This module will detail a brief overview of the anatomy and physiology of skin, an overview of different types of wounds, a review of wound infections and, with an associated understanding of the wound healing process, present a range of wound management products that are suitable for different types of wounds, such as a bleeding or sloughy wound. By understanding the nature of wounds, through which aspect of the skin is damaged and the associated pathophysiology, the available wound management products will become logical. There is unfortunately scarce information regarding wound management in the current Joint Royal College Ambulance Liaison Committee (JRCALC) Guidelines (JRCALC, 2006). Ambulance Trusts will have some form of policy/procedure or guidelines documenting the management of wound care and this CPD module aims to supplement this guidance.

Glucagon treatment for symptomatic beta blocker overdose

February 2012

Symptomatic beta blocker overdose is a relatively uncommon, but potentially life threatening condition (Sheppard, 2006; Health Protection Agency, 2010). Current definitive treatment for these patients involves intravenous glucagon therapy, and as such, glucagon is considered both a first-line treatment and antidote in cases of symptomatic beta blocker overdose (Joint Formulary Committee, 2011; National Poisons Information Service, 2011a; 2011b). This case report examines an intentional overdose of propranolol, including paramedic pre-hospital management, and subsequent in-hospital definitive treatment involving intravenous glucagon therapy. Paramedics have experience and knowledge of administering intramuscular glucagon as part of their formulary, and possess the necessary skills for obtaining intravenous access. Therefore, could intravenous glucagon be considered appropriate for administration by paramedics as a pre-hospital
intervention in cases of symptomatic beta blocker overdose?

Abdominal aortic aneurysm (AAA)

December 2011

An abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta resulting from degenerative cardiovascular disease. Such aneurysmal arteries pose few problems for many patients and are simply monitored and managed conservatively within the community. However, the ruptured abdominal aortic aneurysm is a time-critical medical emergency requiring timely surgical intervention in order to offer any chance of survival. Even when recognized early, 90% of patients will suffer an out-of-hospital cardiac arrest prior to arriving at the emergency department, and of those who reach theatre, only 40% will survive. This article aims to increase the paramedic practitioner’s knowledge and understanding of AAA through a holistic discussion of the prehospital recognition and early management. Particular emphasis will be placed on fluid replacement therapy and analgesia, with specific reference to the issues associated with aggressive fluid resuscitation and the potential benefits elicited through the use of opiate analgesia and subsequent pharmacologically induced hypotension. This article further aims to set the prehospital management into the wider context, thus providing paramedic practitioner’s with an insight into how prehospital interventions affect the patients’ ultimate outcome and post-operative quality of life.

Emergency ultrasound in the prehospital setting

January 2012

This module will explore the breadth and depth of ultrasound use in the prehospital setting. Emergency ultrasound is increasingly being seen as an extension to clinical examination. Emergency ultrasound skills can potentially positively impact upon patient outcome both in terms of out of hospital treatment and also in terms of non-nearest hospital transfer of patients for specialist care. The wide array of potential practice modification promised by prehospital emergency ultrasound need to be introduced carefully and in the context of mentoring and accreditation of potential practitioners. By using reflective questions and establishing learning outcomes, the paramedic will achieve a foundation in the prehospital use of emergency ultrasound.

Diagnosis and management of minor head injury in the UK

March 2012

Head injury accounts for a large amount of emergency services work in the UK. This article summarizes the findings of studies undertaken for the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme examining the available evidence regarding the diagnostic management of minor head injuries. These studies included a review of current practice in the management of minor head injured patients (GCS 13–15) by way of a survey of UK emergency departments. We also performed a systematic review of the head injury literature to identify the most accurate clinical decision rule for adults (Canadian CT Head Rule) and children (Paediatric Emergency Care and Research Network) and commented on the applicability of these in the UK population. This review helped to identify the most significant clinical findings that increase the likelihood of intracranial and neurosurgical injury, following minor head injury in adults, children and infants. Finally, we have highlighted where these findings may be relevant to UK paramedic practice, in particular in influencing the decision to transfer patients to the emergency department.

Neutropenic Sepsis

May 2012

Neutropenic sepsis is the development of a profound and potentially life-threatening episode in patients that are extremely vulnerable due to their diminished ability to fight off infection. This reduced capacity to respond to infective agents – neutropenia - is caused by a near total absence of the body’s specialist white cells, called neutrophils. One of the most commonly found causes of neutropenia are the chemotherapy regimens that patients treated for cancer need to take. There are an increasing number of such regimens being prescribed and, also, a trend towards oncology patients being treated - or recovering from treatment - at home (Dikken, 2009).

The initial signs of these patients becoming overwhelmed by an opportunistic infection are easy to miss as the signs and symptoms are vague. The importance of sepsis being suspected and responded to by paramedic staff is of the utmost importance, as the disease process will progress with alarming speed to a point where it is difficult to support or resuscitate the patient either in the community or in hospital settings.

This article presents an overview of sepsis and how neutropenia disguises the typical presentation, as well as a discussion of pre-hospital care delivery by paramedic staff.

Spine immobilisation: professional and lay perspectives

May 2012

For fifty years the liberal use of precautionary spine immobilisation for trauma patients has gone largely unquestioned. Now though some researchers and practitioners are advocating a more selective approach, with some paramedics already empowered to clear spines at the scene of accidents. This Continuing Professional Development (CPD) module approaches pre-hospital spine immobilisation from two different, but related, perspectives. Firstly the module describes the basic anatomy and pathophysiology of cervical spine injury, explores the history of spine immobilisation, limited evidence base behind it and current professional practice. Secondly the module explores how lay members of the public, who are often the first to arrive at the scene of an accident, think about and manage potential spinal injury. Specifically asking whether some members of the public may erroneously prioritise spine immobilisation at the expense of other life-saving interventions.

Thermal injuries (burns) in the pre-hospital setting

June 2012

This Continuing Professional Development (CPD) module will focus on the aetiology, identification and pre-hospital recognition and management of both adult and paediatric patients presenting with burn injuries. Burns can range from simple, self-limiting injuries that may be managed at home to a life-threatening injury that can lead to life-long disability and pain. Thermal injuries, or burns, probably have the greatest potential to cause the most systemic damage of all damage to skin. This tissue damage and cell death can result from intense heat, electricity, ultra violet (UV) radiation (such as sunburn) or chemical (such as caused by acids). In addition, burns may present in association with other injuries, so may not be assessed initially as the main injury. The severity of the damage caused by burns is often determined by the underlying organ damage.

Management of an isolated neck-of-femur fracture in an elderly patient

July 2012

In the UK, femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered immediately in a stepwise approach, through the variety of options open to paramedics and should be progressive to the patients needs. Fluid management should be considered to stabilise the patient and prepare them for surgery. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive appropriate management before initiation onto a care pathway in hospital.

Tramadol overdose and the potential for seizure after naloxone administration

August 2012

Tramadol is the most widely prescribed opiate analgesic (National Treatment Agency for Substance Misuse, 2011) and, as a result, is present in a large number of overdoses that present in the pre-hospital arena. Naloxone is indicated for use by ambulance personnel where the level of conciousness is reduced due to a known, or possible, overdose of an opiate containing substance (JRCALC, 2006).
A case study of a tramadol overdose shows a close temporal relationship between naloxone administration and a seizure. While seizure is a symptom of tramadol intoxication (Saidi et al, 2008), the speed with which it occurred after naloxone administration seemed too fast to be merely coincidence. A study of the literature shows evidence that naloxone can instigate seizure in the case of a tramadol overdose (Raffa and Stone, 2008 ; Rehni et al, 2008 ).
This information is particularly pertinent to the ambulance clinician as the consequence of a seizure can be important, both practically and clinically. The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose.

Epinephrine and its use in acute life-threatening asthma in adults

September 2012

This CPD module, will act as revision of existing treatments for acute asthma exacerbations, as well as discussing the indications for use of epinephrine in asthma and the potential problems you may encounter with its use.
Although epinephrine has been used for many years in other medical emergencies, such as anaphylaxis, is not widely used for asthma exacerbations. This module will discuss a number of different methods for the delivery of epinephrine; however it should be appreciated that not all of these routes are suitable for use in asthma.
You will also have the opportunity to reflect and consolidate your existing clinical knowledge of epinephrine, as well as providing a basis for further learning about the pre-hospital management of acute asthma exacerbations.
There are a number of resources available through the ‘Journal of Paramedic Practice’, and other guidelines and information available to supplement your learning; in particular from the British Thoracic Society, Scottish Intercollegiate Guidelines Network and Joint Royal Colleges Ambulance Liaison Committee.

Considering and applying pharmacokinetics

October 2012

Managing medicines in modern healthcare practice is a significant issue for all healthcare professionals. Paramedics have a particular role in managing medication in acute care settings and those environments are often the most challenging. Despite this key role; many healthcare professions are often afforded little opportunity to consider the science behind medicines management behaviours.

This article explores, in a reflective manner, the principal actions of the body on the drugs we administer in attempt to assist the paramedic practitioner to make greater sense of the effects of medication in practice. The article explores the theory behind considering the absorption, distribution, metabolism and excretion (ADME) of medicines and highlights how ADME considerations are made in everyday practice. The reader is asked to reflect upon the value of this information and take forward a model of understanding pharmacokinetics in the context of caring for patients.

Assessment of the 12 lead ECG in transient loss of consciousness

December 2012

Cardiac arrhythmia affects more than 700 000 people in England, and is consistently in the top ten reasons for admission, placing a significant strain on emergency department time and bed availability (DH, 2005). Following the introduction of pre-hospital thrombolysis as part of the National Service Framework (NSF) for Coronary Heart Disease (CHD), the acquisition and interpretation of 12 lead ECGs has become a routine part of UK paramedic practice. Although training models have varied nationally, the main focus has been on the use of 12 lead ECGs to identify changes associated with ST elevation myocardial infarction (STEMI) in order to facilitate early reperfusion measures.

Changes in Vital Signs of Trauma Victims from the Pre-Hospital to the Hospital Settings and their Associations with Injury Severity and a Need for an Emergent Operation

January 2013

The objective of this article is to characterize changes in vital signs of trauma victims from pre-hospital to hospital settings, their associations with injury severity, and the need for an emergency operation. Methods: a prospective cohort included 601 patients admitted to a level one trauma centre from 1 July to 30 September 2007. All pre-hospital and hospital admission values of Glasgow coma score (GCS), systolic blood pressure (SBP), heart rate (HR), respiratory rate (Resp) and oxygen saturation (SpO2) were recorded. All urgent major surgical procedures were graded in real-time as: emergency, urgent, or not urgent. Injury severity score (ISS) was calculated following completion of all the diagnostic work-up. Patients were classified as major trauma victims if their calculated ISS was 16 or greater, and those who needed an urgent intervention or intensive care. Vital signs trends were analyzed using the students’ T–test. Associations with injury severity and the need for an emergency operation were analyzed using chi-squared test. The statistical significance level was set at 5% (P ≤ 0.05). Results: 243(40%) patients were classified as major trauma. 39(6.5%) patients required an emergency operative intervention—29 for active bleeding and 10 for imminent cerebral herniation. The time from injury to hospital arrival was 44.8 ± 17.63 minutes (mean±standard deviation), the time did not differ for those needing an emergency operation. Pre-hospital GCS ≤12 and SBP ≤90 were associated with a severe injury (a relative risk(RR) of 4.95, 95 % confidence interval(CI) 3.25–7.58 for low GCS and 4.60, 2.67–7.94 for low SBP) and emergency surgical procedures (RR, 95 % CI 4.43, 2.28–8.58 for low GCS and 11.69, 5.85–23.36 for low SBP). These values changed significantly from the field to the hospital with the mean GCS increasing 1.65 points and the mean SBP decreasing 7.23 mmHg (P<0.001). One patient out of 473 with a GCS ≥14 in the field and no one out of 483 patients with a GCS ≥14 on admission needed a neurosurgical procedure. 15/533(2.8%) patients with a pre-hospital SBP >90, and only 2/542(0.4%) patients with a SBP >90 on admission required emergency bleeding control (P<0.005). HR ≥120 and changes in HR of 20 beats per minute (bpm) or more were not associated with injury severity. The respiratory rate and the SpO2 did not change significantly, and were not associated with injury severity. Conclusion: pre-hospital vital signs values are expected to change significantly over time. Pre-hospital GCS ≤12 and SBP ≤90 predict major trauma, while the HR is not a good indicator of haemodynamic status. When these parameters normalize on admission, an emergency operation is rarely needed.

Tension pneumothorax

January 2013

Tension pneumothorax is a life threatening complication of chest injury. It can cause rapid physiological decompensation, cardiac arrest and death. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provide guidelines on the pre-hospital diagnosis and treatment of this condition. This Continuing Professional Development (CPD) module firstly looks at the pathophysiology of the developing tension pneumothorax, discusses the signs and symptoms likely and less likely to be found, looks at the difficulties in recognising these signs and analyses the accepted methods of first line treatment. The module goes on to study alternative pre-hospital management methods and discusses the safety and effectiveness of each.

Pain management for paramedic practice

June 2013

This CPD Module will outline the definitions and presentation of overarching typology of acute and chronic (or persistent) non-malignant and malignant pain, describe the anatomy and physiology relating to pain and review the pharmacology of pain medication in the UK for children and adults. This CPD module is advisory and does not seek to replace any locally agreed policies/procedures within your organisation or national policies and guidelines related to pain management. This module aims to provide you with a background to pain, its various types, some pain assessment tools and the pharmacological action of the common analgesic agents, and therefore a greater understanding of managing patients presenting in pain, their presenting symptoms, underlying pathology and their management.

Decision making for paramedic practice

May 2013

Making decisions is something we all do several times a day. For the majority of the time, such decisions are made unconsciously or certainly with little regard or much thought or insight into the decision making process itself. However, some of life’s bigger decisions tend to be taken more seriously and we often consult with others, such as family, friends and colleagues,
undertake some research, or look at various websites before making these choices. In your clinical and professional paramedic life, many of the decisions that you make on a daily basis can vary enormously; from saving someone’s life, to deciding which health care professional to refer a patient to. All are undertaken with perhaps little thought to the decision making framework or theories that underpin your practice. As many of your decisions are fundamental to patient care, it is important to have a greater understanding as to how we reach the decision that we do, why we make them and how we could improve on them. This Continuing Professional Development (CPD) module will explore some of these supporting processes and how they specifically relate to paramedic practice.

Basic pathophysiology of shock

May 2013

This continuing professional development (CPD) module will focus on the basic underlying physiology of shock; an acute syndrome of inadequate tissue perfusion. Shock is a medical emergency requiring urgent attention and transport to hospital. Given its vast aetiological range, it is an important topic for paramedics and ambulance staff to understand.

Gout: A new focus on an old disease

February 2013

Gout is an increasingly common condition predominantly affecting middle aged men. Although commonly related to the intake rich foods, a raised serum uric acid level also causes gout. Gout may present in the pre-hospital setting due to the intensity of the key presenting symptom – that of pain.

This Continuing Professional Development (CPD) module focuses at the aetiology and incidence of gout, discusses the presenting signs and symptoms likely and suggested management plan. Although patients with gout rarely require hospital admission, a differential diagnosis of septic arthritis should be excluded and patients may require referral to the Emergency Department to confirm or exclude this diagnosis.

Clinical leadership for paramedic practice

May 2013

The aim of this CPD module is to outline and describe the concept of clinical leadership for paramedic practice and the ambulance service. Clinical leadership has been defined as ‘the ability to both create and sustain an organisational culture of excellence through continual development and improvement’ (Pintar et al, 2007: 115). Clinical Leadership sets out to focus and motivate individuals within an organisation to facilitate their achievement of clinical and professional aims..

Critical thinking for paramedic practice

July 2013

This CPD Module will focus on the concept of critical thinking for paramedic practice and the various models that you can use in order to develop your critical thinking skills. The more astute amongst you will notice that the models presented and discussed might be familiar to you as those used in assisting you with reflecting on your practice. However, by developing these models further, it is possible to understand that these models are not simply a tool by which to describe and highlight various issues from a clinical incident, but about beginning to develop a life-long approach to challenging and learning from these incidents.

Thermoregulation and heat illness

August 2013

This Continuing Professional Development (CPD) Module will first outline the scientific principles behind heat transfer, before moving on to discuss the body’s physiological response to changes in temperature. Finally, we will discuss the pathophysiology and treatment of heat illness before concluding with a series of multiple choice questions.

Recognition and treatment of hypothermia

October 2013

Accidental hypothermia is a condition which affects not only outdoor enthusiasts caught in storms, but also a significant proportion of the elderly population of countries such as the UK during winter months. Interestingly, hypothermia is both a symptom of illness and a distinct pathology in itself. With this in mind, it is an important condition for paramedics and pre-hospital medical staff to understand.

This Continuing Professional Development (CPD) module will briefly revise some of the principles of heat transfer and thermoregulation discussed previously, before discussing the pathophysiology and management of hypothermic states

Head injury

November 2013

This Continuing Professional Development (CPD) module will outline the epidemiology and pathophysiology of head injury, before defining categories of head injury and important details concerning their pre-hospital management.

The causes and paramedic management of bradycardia in the out-of-hospital setting

December 2013

This Continuing Professional Development (CPD) module will outline the normal anatomy and physiology of the heart before considering the paramedic approach to causes and management of bradycardia in the out-of-hospital setting. There are a number of self-directed activities to complete as you move through the article together with a list of further resources to expand your research. This article requires the reader to have a basic appreciation of normal cardiovascular anatomy and physiology, and an appreciation of the general approach to assessing and managing patients in the out-of-hospital, emergency setting before completion.

Common paediatric illnesses part one—identification and management

February 2014

This Continuing Professional Development (CPD) module will focus on the identification and management of common paediatric illnesses, their history, epidemiology, key signs and symptoms, transmission, complications and specific treatments. This module will also present the current list of notifiable diseases in the UK.

Common paediatric illnesses part two—identification, management of infectious illnesses and the associated immunisation schedule

March 2014

This Continuing Professional Development (CPD) module is the second part of a series of two modules that focus on the identification and management of common, preventable paediatric illnesses, their history, epidemiology, key signs and symptoms, transmission, complications and specific treatments. This module will also outline the current childhood immunisation schedule in the UK.

Basic pathophysiology and the BTS/SIGN guidelines for treatment of asthma in adults

April 2014

This Continuing Professional Development (CPD) Module will focus on the basic underlying mechanisms of disease in asthma: a chronic respiratory disease characterised by recurrent episodes of airway constriction.


April 2014

This Continuing Professional Development (CPD) Module will discuss the principles of partial pressures of gas, how the partial pressure of expired carbon dioxide is measured and review examples of the waveforms produced by ventilated patients.

Venous thromboembolism

June 2014

This Continued Professional Development article will outline the epidemiology and risk factors surrounding venous thromboembolism (VTE), a disease which encompasses the pathology of both deep vein thrombosis (DVT) and pulmonary embolism (PE). This article will allow the reader to understand the subtypes of VTE and their management in an acute setting.

Major trauma and catastrophic haemorrhage

June 2014

Major trauma is a leading worldwide cause of mortality, killing or seriously injuring thousands of people each day. Casualties have the potential to die immediately as a result of massive head injury or rupture of major vessels, or shortly afterwards as a result of progressive blood loss and hypoxia. A third group survive the initial insult, but succumb to their wounds days or weeks later as a result of secondary conditions including multiple organ failure and sepsis. This Continuing Professional Development (CPD) module will focus on the rapid assessment and timely management of casualties of major trauma, with particular emphasis placed on the catastrophically haemorrhaging patient.

Managing anaphylaxis in the out-of-hospital setting

August 2014

This Continuing Professional Development (CPD) module will explore the most severe form of allergic reactions, anaphylaxis. This will include outlining the definition, prevalence, pathophysiology and paramedic management of the disease. There are a number of self-directed activities to complete as you move through the article together with a list of further resources to expand your research. This article requires the reader to have a basic appreciation of normal physiology associated with the immune system and an appreciation of the general approach to assessing and managing patients in the out-of-hospital, emergency setting before completion.

An outline of acute and chronic complications of diabetes

September 2014

Although a common condition, the mechanisms of diabetes are not always simple to understand, and requires concentration as well as an appreciation of multiple body systems. This Continuing Professional Development (CPD) module will hopefully further your knowledge of the physiology of diabetes and help you to understand why diabetes and its complications present as a particular set of symptoms.

Managing premature babies in the pre-hospital environment

October 2014

Babies born at ≥37 weeks of gestation are considered to be born at term; therefore, any baby born earlier than 37 completed weeks of gestation are termed as premature babies. A consistent rise in preterm birth rate has been noted around the world (Norman et al, 2009). Available statistics from the United States shows that preterm births constituted 12.8% of live births in 2006; this is an increase by 20% since 1990 (Muglia and Katz, 2010). The challenges that result from preterm delivery will vary depending largely on the gestational age and birth weight. The general rule is that adaptation of the newborn to extra-uterine environment becomes more problematic with smaller and less mature babies. It is therefore important to understand some definitions related to the gestational age and weight.

Tranexamic acid in the pre-hospital care of trauma patients

December 2014

This Continuing Professional Development (CPD) module will explore the use of tranexamic acid (an antifibrinolytic) in pre-hospital trauma patients. A review of the current guidelines is provided along with considerations for its use in the future.

Understanding flu

January 2015

Influenza is a viral infection that causes seasonal illness and sporadic epidemics and pandemics. Immunisation remains the single most effective way of preventing influenza, although seasonal vaccines cannot prevent all cases. This Continuing Professional Development (CPD) module reviews the prevention and management of flu, and dispels the many myths that still exist about vaccination.

Paracetamol overdose

February 2015

This Continuing Professional Development (CPD) module considers paracetamol overdose—both accidental and deliberate—in the pre-hospital setting, and presents an update on current practices that paramedics need to be conversant with in responding to what is a dangerous and potentially fatal situation.

Review of the current management guidelines of chronic obstructive pulmonary disease (COPD)

March 2015

By the end of this Continuing Professional Development (CPD) module readers will have an improved understanding of the management of chronic obstructive pulmonary disease (COPD) exacerbation. They will also be up-to-date with current clinical thinking regarding use of oxygen therapy, and the controversy around it.

An introduction to IV drug administration and toxicology for paramedics

April 2015

This Continuing Professional Development (CPD) module will explore the use of intravenous (IV) drugs in the out-of-hospital setting by paramedics. It will focus on the importance of drug dosage by examining basic pharmacokinetics, toxicity and factors that may influence your clinical decision-making when using IV analgesia. It will use IV paracetamol as an example to illustrate these principles. There are a number of self-directed activities to complete as you move through the article together with a list of further resources that are used to reference this article and to expand your research. This article requires the reader to have an appreciation of basic anatomy and physiology and an awareness of the general approach to assessing and managing patients in the out-of-hospital, emergency setting before completion.

Acute community-acquired pneumonia

May 2015

This Continuing Professional Development (CPD) module will explore acute community-acquired pneumonia (CAP). The pathophysiology and epidemiology of CAP will be discussed, before highlighting key diagnostic features and how it can be managed by paramedics in the pre-hospital setting.

Grief, loss and bereavement

June 2015

This Continuing Professional Development (CPD) module will explore grief, loss and bereavement as it relates to paramedic practice. It will outline the key theories of loss and bereavement, and describe how these theories have developed over the years. Rather than focusing on the causes of bereavement or loss, it will outline the underpinning theories as to the potential presentation of bereaved individuals and some management strategies. Your employing organisation may also have clinical policy and/or guidelines relating to identifying and managing bereaved individuals.

Paediatric seizures

July 2015

This CPD module will use a case study to provide an overview of paediatric seizure management. This includes the fundamental pathophysiology and pharmacology, as well as key points in assessment and management.

Update on the management of sepsis: what a paramedic needs to know

August 2015

This Continuing Professional Development (CPD) module will provide a brief reminder of the definitions of sepsis and septic shock before describing the key diagnostic criteria, outlining risk stratification in the pre-hospital setting, and detailing how these patients can be treated according to current guidelines.

Evaluating classifications of heart failure

September 2015

This Continuing Professional Development (CPD) article will explore the subject of heart failure looking at different types of classifications, diagnosis criteria and considerations of patient assessment and management for the paramedic. It will look at scoring systems and objective evidence to help you decide what sort of heart failure your patient may be presenting with.

Recognising oral and facial conditions

October 2015

This Continuing Professional Development (CPD) article will focus on conditions which may affect the face and oral cavity. It will provide an outline of each condition and consider the possible cause or origin. Finally, it will discuss how to recognise when presentations warrant immediate medical admission, or can be referred to other healthcare practitioners in the community setting.

Cerebrovascular accident management in the pre-hospital setting

November 2015

This Continuing Professional Development (CPD) article will look at cerebrovascular accident. It will outline the pathophysiology and epidemiology of acute cerebrovascular accident, and identify key diagnositc features, including cause and physical presentation. Finally, it will discuss how an acute cerebrovascular accident can be managed by paramedics.

Understanding and identifying upper airway infections

January 2016

This Continuing Professional Development (CPD) module will look at conditions that affect the upper respiratory tract including pharyngitis, laryngitis, tonsillitis, tracheitis, epiglottitis and croup. It will review the anatomy and physiology of the respiratory system, before considering typical medical presentations and possible treatment options for paramedics.

Management of sickle cell anaemia in the pre-hospital setting

January 2016

This Continuing Professional Development (CPD) module will provide the reader with an overview of the pathophysiology of sickle cell anaemia and how this causes acute painful crisis. The reader will also be reminded of the pre hospital management of this condition together with a recap of community-based treatments which help prevent exacerbations.

Establishing an emergency airway

February 2016

This Continuing Professional Development (CPD) module will consider respiratory arrest in the pre-hospital setting and how the paramedic can establish an emergency airway. It will identify the common causes of respiratory arrest, as well as the key steps in performing a respiratory assessment. Details of the various airway management strategies are also outlined.

Exploring the presentation and management of cardiogenic shock

March 2016

This Continuing Professional Development (CPD) module will explore the presentation and management of critically unwell patients suffering from a form of obstructive shock in the out-of-hospital setting. There are a number of self-directed activities to complete as you move through the article together with a list of further resources that are used to reference this article and to expand your research. This article requires the reader to have an appreciation of basic anatomy and physiology and an awareness of the general approach to assessing and managing patients in the out-of-hospital, emergency setting before completion.

Exploring endocrinology

April 2016

This Continuing Professional Development (CPD) module will look at how the body organises change through hormone control, exploring the subject of endocrinology. It will support the paramedic to think about the normal functions of common hormones from the level of origin through to target end organs. It will also help us to think about endocrinology-related diseases, in terms of when those hormones are over-produced or under-utilised and the clinical implementation of what that means to paramedic practice.

Understanding paramedic treatment and management of pulmonary embolism

May 2016

Pulmonary embolism (PE) is one of the most common preventable deaths in the UK. Causing occlusion of the pulmonary arteries, a PE is most often caused by the formation of a deep vein thrombosis (DVT) which ‘breaks free’ and travels to the lungs where it alters the normal ventilation/perfusion (V/Q) relationship, resulting in hypoxia, increased dead space and intrapulmonary shunting.

This Continuing Professional Development (CPD) module will explore the pathophysiology, assessment and management of PE by paramedics, and explore the condition’s main causes and treatment from the paramedic’s perspective.

Stroke and transient ischaemic attack—risk factors, identification and assessment

June 2016

This Continuing Professional Development (CPD) module will outline key factors in acute stroke assessment in adults, risk factors associated with strokes, and provide an overview of a provisional diagnosis and an overview of current treatment for acute stroke. While specific stroke treatments are outside the remit of paramedic and pre-hospital practice, similarities do exist in the treatment for acute myocardial infarction: time is of the essence. Therefore a brief overview of the current treatment for ischaemic stroke, such as thrombolysis and thrombectomy, will be the focus of this module.

Considering tissue viability in the pre-hospital setting

July 2016

This Continuing Professional Development (CPD) module will look at the subject of tissue viability and will give the paramedic an appreciation of the different elements of wound considerations and the healing process. From this, paramedic practice around assessing wound care may be enhanced.

Prehospital management of severe traumatic brain injury

September 2016

This Continuing Professional Development (CPD) module will explain how to treat a patient with a traumatic brain injury, with reference to elements such as the intracranial compartment, cerebral blood flow, and a practical case study. From this, a paramedic may enhance their practice around stabilising a patient with severe head injuries in a pre-hospital setting.

Alcohol-use disorder

October 2016

Paramedics often attend patients with long-term alcohol problems. This article aims to give paramedics an insight into the breadth of complexity of these alcohol-dependent individuals and the necessary considerations for clinical care in the out-of-hospital environment.

The paramedic and gynaecology

October 2016

This module will introduce the subject of common gynaecology-related presentations and link their relevance to paramedic practice. It will explore irregular periods, heavy periods, painful periods, painful sex, pelvic inflammatory disease, menstrual-related tensions, sterilisation and termination of pregnancy.

Ethical and legal perspectives of consent, duty of care and negligence in paramedic practice

January 2017

This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and nonmaleficence. Ethical and legal aspects of clinical practice are regularly incorporated into paramedic education programmes, but as with many professional issues, theory is perhaps best understood when applied to clinical practice.

Assessment and management of stab injuries

January 2017

This CPD module will focus on the pre-hospital assessment and management of patients with penetrating traumatic injuries. Whilst the predominant focus is on wounds sustained in knife attacks, the same principles are readily transferrable to the management of all penetrating injuries, intentional or otherwise. For instance, the management of a stab victim with the knife left in situ will bear many similarities to the management of a patient impaled in an industrial accident or road traffic collision. For this reason alone, it is an important area for paramedics and pre-hospital care providers to understand.

Cardiogenic shock

January 2017

This module will explore the delivery and theory of chest compressions used in the out of hospital setting. There are a number of self-directed activities to complete as you move through the article together with a list of further resources that are used to reference this article and to expand your research. This article requires the reader to have an appreciation of basic anatomy and physiology and an awareness of the general approach to assessing and managing patients in the out of hospital, emergency setting before completion.

Diabetes in pre-hospital care

March 2017

If ever there was a disease which could win an award for being complex, diabetes would definitely be up there. Diabetes Mellitus (DM) is a long term condition of high blood sugar. It is a condition of hormones, a condition of metabolism and a condition of inflammation. These multiple aspects give rise to various long term complications that the paramedic should be aware of. This module discusses the complexities that could present to paramedics when attending to a diabetic patient in pre-hospital settings.

End-of-Life Care

April 2017

This CPD module will outline some of the challenges for the patient at the planned end of their life. End of life care is a specialism which paramedics as the ‘go to’ provider of out-of-hours healthcare are often faced with. It will cover a number of conditions which can no-longer be cured, but instead, treatment is designed to be palliative. We will focus on some of the emergencies such as secretions, bleeding and pain in the end stages of life.

Vertigo and pre-hospital care

May 2017

In this CPD module, we will look at the symptoms of vertigo. Vertigo dizziness is a presentation that paramedics may face, and is often associated with other presentations, such as head injury, stroke and benign pathology. This module will explore some of the different causes of vertigo and how the paramedic can approach this in a safe way, considering the different pathophysiology of each type of vertigo.

Highlighting the law and ethics of pain relief in end-of-life patients

August 2017

This Continuing Professional Development (CPD) module explores the ethical and legal issues surrounding pain relief for end-of-life patients by paramedics. Particular attention is focused on the moral and ethical principles of care as proposed by Beauchamp and Childress (2008), as well as the legal aspects of care as set out by the European Convention of Human Rights. Through the use of law cases, this module looks to demonstrate precedence for practice, as well as the implications that arise thereof.

June CPD: Pre-hospital use of rigid cervical collar

July 2017

It has been widely acknowledged that evidence supporting the use of cervical collar has been lacking, and that its use was therefore based upon hypothetical benefit. However, modern evidence challenges the very principle of immobilisations on which the collar’s use was justified, and argues that the cervical collar is an ineffective immobilisation tool regardless. Cervical collars have always been thought to be a relatively harmless measure. Evidence suggests that the application of cervical collars can be harmful to patients. An assessment of today’s evidence justifies an immediate change of practice, and EMS providers across the world are adapting accordingly. Practice change in the UK is well overdue.

6Cs of healthcare, and evaluation

July 2017

This article explores how the Compassion in Practice vision and actions can be embedded into the world of clinical research. While it is accepted that not all clinical research is undertaken within the NHS, this article focuses on those research patients within the public service, but with recognition that the principles discussed have the potential to be translated with ease into other areas. Another important area of paramedic practice is evaluation. Overall, the purpose at all levels is to evaluate the effectiveness of training and to use the results to evidence change and improvement which compliments EG.

Considering infections of the heart

September 2017

This Continuing Professional Development (CPD) module discusses the three main groups of cardiac infections (pericarditis, myocarditis, and endocarditis). It then highlights how they can be identified in the pre-hospital setting and how the ambulance service can contribute to the subsequent diagnosis of patients presenting with these conditions.

The challenges of paediatric trauma care

October 2017

This Continuing Professional Development (CPD) module explores the challenges paediatric trauma presents to pre-hospital and emergency clinicians. There has been a nationally increased focus to improve the quality of trauma care in the UK, leading to the development of regional trauma networks in 2012. This focus includes children. This module will discuss the challenges and issues of dealing with paediatric trauma and how some of the problems encountered might be mitigated.

Using clinical decision making and reflection strategies to support practice

November 2017

This Continuing Professional Development (CPD) module explores clinical decision making and reflection for paramedics. Both skills are essential for any healthcare professional to possess in that they underpin and enhance practice by providing a robust framework for structuring one’s thinking and subsequent actions.

This article highlights the need for the study of clinical decision making, which forms a vital part of the paramedic’s practice. It provides a background to clinical decision making before presenting an example case study.

Fundamentals of blood pressure measurement

December 2017

This Continuing Professional Development (CPD) looks at how the body regulates blood pressure, what a healthy blood pressure is, how it should be measured and what happens when blood pressure rises or falls. It is important for paramedics to recognise possible causes of blood pressure changes, understand how these fluctuations occur and how to measure blood pressure accurately.

Vital airway management skills when treating a pulmonary embolism

January 2018

A pulmonary embolism (PE) is an occlusion of the pulmonary artery that occurs because of a thrombus originating from a deep vein thrombosis. In this CPD module, we will highlight key steps in performing respiratory assessment of a patient with PE, and outline paramedic treatment and management of this condition. A PE results in ventilation with a reduced perfusion. Early intervention to maintain the airway and facilitate oxygen delivery can reduce PE-associated mortality.

The role of the paramedic in sepsis management

February 2018

Sepsis is a potentially life-threatening complication of an infection and involves a complex array of inflammatory responses. Sepsis is usually caused by bacterial, viral, or fungal infections that are likely to develop into pneumonia, abdominal infections and kidney infections. Sepsis has gained increasing publicity in recent years and is now a strong focus of clinical education following the launch of the ‘Surviving Sepsis’ campaign. Paramedics need to understand the pathophysiological process associated with sepsis, and how these may present in patients.

Pain management in children in the pre-hospital environment

March 2018

Pain management is complex in children. Age, developmental level, and both cognitive and communication skills, as well as associated beliefs must be considered. Pain can have psychological, physical and social consequences, all of which impact quality of life. Without effective pain treatment, there are risks of long-term changes in stress hormone responses, pain perception and post-traumatic stress disorder. The current article helps to shed light on a number of difficulties faced when managing pain in children, and how to overcome them.

Reflecting on our own professional values and behaviours as paramedics

April 2018

Professional values and behaviours of paramedics often influence our clinical performance, as well as our ability to actively and professionally interact with colleagues, patients and the multi-professional healthcare team. This short CPD article explores how our behaviour, and that of colleagues, inform and shape our interactions with people whose values may differ from our own (Clompus and Albarran, 2016).

Pulmonary embolism in pre-hospital care

May 2018

Pulmonary embolism (PE) is a potentially life-threatening disease, which presents with non-specific signs and symptoms. Evidence suggests that diagnosis is often made on post-mortem examination and misdiagnosis is likely. There are a number of pathophysiological processes that occur in acute PE, which have several systemic effects on the body and the compensatory mechanisms. A thorough understanding of these physiological processes and how these manifest will afford the attending clinician a greater knowledge base on which to develop clinical reasoning skills, therefore initiating timely management and transportation to definitive care. Clinicians should also have an awareness of adjunctive therapies available in the management of PE, which include inotropic support for profound shock and thrombolytic therapy in cardiac arrest. This article explores the pathophysiology of the disease process, the identification and pre-hospital management of PE.

End of life care in the community: the role of ambulance clinicians

June 2018

Ambulance clinicians are frequently called to patients who are approaching the end of their life. This article presents an overview of some of the issues that impact on the delivery of care to patients at the end of life, including symptom and urgent care needs in the last few days of life; preferences for care/place of care; and coordination of care. Each of these areas pose different challenges for ambulance clinicians. As a way of addressing some of the issues, this article outlines an online education package in end-of-life care, which has been specifically designed for ambulance clinicians in response to an analysis of their training needs. The learning outcomes and educational approach is described. The education aims to help equip ambulance clinicians with the knowledge and confidence that they need to deliver high-quality urgent end-of-life care.

A brief guide to borderline personality disorder in an emergency setting

July 2018

Paramedics and ambulance staff are frequently in contact with patients who have mental health diagnoses. This may be the primary reason for contacting the emergency services (e.g. self-harm, crisis or suicide ideation) or it may be incidental to their primary clinical concern. Patients in mental health crisis can be challenging and demanding. Most paramedics will not have had specific guidance on identifying or understanding the features, aetiology and responses to treatment of patients with a diagnosis of borderline personality disorder. Borderline personality disorder is associated with a high risk of self-harm, risk-taking behaviour and suicide. Building a rapport with patients is often crucial to paramedics achieving optimum patient care. There are features of borderline personality disorder that may make rapport-building more complex, and the establishment of trust harder for the clinician to achieve and maintain. There is potential for frustration and a lack of understanding to interfere with the successful delivery of person-centred care. In order to support patients with borderline personality disorder, ambulance staff need to be aware of the particular characteristics of this condition and the current best practice guidance.

Understanding an alternative approach to paramedic leadership

July 2018

Leadership is an essential feature of the life of a paramedic. During incidents, while working with multi-agency colleagues, and within organisations, leadership is an expected quality for paramedics to have. Across health and social care organisations, leadership is said to be of pivotal importance to future success. This has led to a large investment in leadership development programmes that organisations are now seeking to justify. Leadership as a concept, however, is complex and multifaceted. The nature of leadership has been debated over millennia and disagreement remains as to how to define it. The current article uses Critical Interpretive Synthesis to consider how approaches to leadership have developed over time. It concludes with a synthesising argument that leadership is a social construct; as such, no single definition will ever be appropriate. However, the four elements that comprise the leadership equation should be considered if the paramedic leader is to be effective.

Advanced care planning in end-of-life care: the key role of ambulance services

September 2018

Effective communication and coordination between individual care providers is vitally important to ensure that patients’ wishes are respected throughout their care and when they die, as well as that families and loved ones are supported following the patient’s death. Ambulance services play an increasingly key role in end-of-life care and this is especially true in terms of transfer of the dying patient (NEoLCP, 2012). This month’s continuing professional development (CPD) article will explore advanced care planning and, in particular, it will focus on do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, advanced decisions to refuse treatment (ADRTs) and rapid discharge transfers.

Heart block as a complication of acute myocardial infarction: the anatomical and physiological mechanisms

October 2018

Heart block (HB) is a recognised complication of acute myocardial infarction (AMI) and is often a marker for increased mortality and morbidity. An appreciation of the anatomical and physiological mechanisms associated with the development of HB in AMI is important for the prediction and management of complications when dealing with such cases. Certain forms of HB are classically linked to infarction of specific anatomical territories in AMI. However, variations in pre-morbid state and anatomy of the coronary vessels provide potential for the development of HB in any patient experiencing AMI, regardless of the territory affected.

Use of targeted temperature management post cardiac arrest

November 2018

The term targeted temperature management (TTM) is used to describe the management of a patient’s body temperature following cardiac arrest and has replaced the term therapeutic hypothermia. TTM has three phases: induction, maintenance and rewarming. A targeted temperature is set to provide neuroprotection and better clinical outcomes for post cardiac arrest patients. The targeted temperature ranges between 32 and 36°C for 12–24 hours with the avoidance of hyperthermia for up to 72 hours. There are three common methods to undertake TTM: conventional cooling techniques, surface cooling systems and intravascular cooling systems. Nurses need to be able to apply, monitor and manipulate the system being used to ensure provision of adequate TTM. Nurses will also need to monitor the patient for physiological changes that can occur as a result of the TTM and apply treatment strategies where appropriate. The European Resuscitation Council (2015) has published guidelines on the use of TTM in post cardiac arrest patients and these will also be discussed.

Key dermatological presentations for the paramedic

December 2018

This article presents an overview of the additional aspects of history-taking that need to be considered when assessing patients presenting with a rash. This relies on strong underpinning anatomy and physiology knowledge to correlate the skin presentation to what may be happening pathophysiologically within the patient’s skin. Four case studies are presented, with leading questions which are then explained. The overall aim of this article is to provide an introduction to key dermatological presentations for the paramedic as a starting point for more thorough reading and exploration on the subject. Download the full article <a href="">here</a>

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