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About Journal of Paramedic Practice

Journal of Paramedic Practice (JPP) is the only monthly peer-reviewed journal dedicated to the clinical and professional needs of paramedics. It is a vital resource for helping paramedics enhance their professional knowledge and stay ahead of all their continuing professional development (CPD) requirements.

Latest CPD

Achieve your CPD with JPP We offer a programme of 12 online reflective practice CPD modules per year. In consultation with experts, the online CPD modules will aim to cover core topics of practice relevant for paramedics, including the key area of pharmacology. Website subscribers can access our latest and archive modules, a selection of which can be found below. Subscribe Today

Fear in the paramedic clinical environment

This article focuses on the physiological, emotional and behavioural response that is fear and considers how it impacts clinical practice. It may have some benefits; for example, the release of the stress hormone cortisol which can increase cognitive function and short-term memory improving information handling. Equally, it poses significant risks, such as loss of perspective, damage to clinician-patient rapport and information bias. The author considers how fear can affect the individual response to a threatening situation in the prehospital care environment and explores ways in which it can be managed.

An out-of-hospital perspective on hyperventilation syndrome

Hyperventilation and tachypnoea both involve breathing at an increased rate. There are a variety of causes of hyperventilation and conditions associated with it, including acute and chronic hyperventilation syndrome (HVS). The characteristics of HVS are not well defined. It results from a reduction in carbon dioxide and altered pH in the body from overbreathing. Symptoms vary between individuals but usually include altered sensations in the extremities, nausea and headache. Diagnosing patients with this condition can be difficult; diagnostic tools include the hyperventilation provocation test, voluntary overbreathing, the Nijmegen questionnaire and the exclusion of physiological causes in the acute situation. There are various prehospital patient presentations and differentiating between potential underlying causes is vital to appropriate treatment and patient safety. Treatments vary in nature, depending on the desired effect and the clinician's scope of practice. Some aim to reduce the frequency and intensity of attacks while others combat the attack when it strikes. This review briefly discusses some treatments available to a clinician with a basic skill level. There is a lack of evidence in this area, and research with a focus on the out-of-hospital environment is recommended. Because of controversy over existing research regarding the definition of HVS, a review of all sources was conducted to produce a definition. This suggests that HVS is a collection of physical and biochemical reactions from an unnecessarily increased respiratory rate that occurs because of an unknown or benign aetiology which can be triggered by anxiety in the absence of other external factors.

Diabetes and associated diabetic emergencies

Diabetes is a group of metabolic diseases characterised by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic complications of diabetes include accelerated development of cardiovascular disease, end-stage renal disease, loss of visual acuity, and limb amputations. However, in the acute situation, diabetes can result in conditions such as diabetic ketoacidosis and hyperosmolar hyperglycemic state, both of which have the same cause: insufficient insulin. This article explores the physiology of glucose control, the pathophysiology of diabetes and the role of the paramedic in the prehospital treatment of the diabetic emergencies, diabetic ketoacidosis and hyperosmolar hyperglycemic state.

Clinical decision-making and its place in paramedic practice

In the pre-hospital environment, paramedics are required to make clinical decisions, often rapidly to ensure correct treatment and care is provided. Decisions made by paramedics majorly impacts on the life, clinical outcome, safety, health and wellbeing of their patients. With the introduction of the Newly Qualified Paramedic Framework, it potentially has never been more pertinent to examine the decision-making process-an integral part of paramedicine. The implementation of the NQP framework has prompted an exploration into clinical decision making and its place in an ever-evolving profession. Through examination of theories and frameworks, this article aims to identify the underpinning evidence that enables a paramedic to reach a competent decision and the barriers experienced in the process.

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