Available 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.
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.
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