Journal Of Paramedic Practice

Hypothermia: exploring causes and treatment options

The regulation of a patient's body temperature is a key part of a paramedic's duty during treatment. Preventing hypothermia by keeping a core body temperature above 35°C and providing sufficient warming devices to prevent changes in body temperature requires careful assessment, monitoring and training. Critical factors in achieving this include assessment of the patient's exposure to the cold, and understanding of the risks linked to hypothermia—especially in older patients who are at risk of a fatal reaction if the body's temperature drops.

What's that rash? Key dermatological presentations for the paramedic

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.

Use of targeted temperature management post cardiac arrest

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.

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

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.

Homelessness: implications for paramedic practice

February 2019

Key facts on homelessnessThe full extent of homelessness and rough sleeping in the UK is difficult to describe. Homelessness is recorded differently in each nation, and not all homeless people show up in official statistics. However, it is clear that homelessness and rough sleeping have been increasing substantially since a low point between 2009 and 2010.Statutory homelessness statistics reported that the local authorities in England had duty to accommodate just over 59 000 households in 2016–2017. This is a 48% increase on the 40 020 reported in 2009–2010. In addition, the estimated numbers of people who sleep rough have increased by 169% since 2010 to 4751 (Ministry of Housing, Communities and Local Government, 2018a; 2018b).

Methoxyflurane (Penthrox®)—a case series of use in the prehospital setting

February 2019

Methoxyflurane (Penthrox®) is a fluorinated hydrocarbon, which when first used in general anaesthesia was noted to have strong analgesic properties in subanaesthetic dosage. More than 5 million doses have been sold for use in Australia since 1978 and have been found to have an excellent safety profile. After rigorous review by the Medicines and Healthcare Regulatory Agency, methoxyflurane was granted a product licence in 2015 in the UK and Europe for the relief of pain in patients with moderate-to-severe trauma. This paper presents the first reported case series of patients treated with methoxyflurane in the UK and Ireland in the prehospital environment. The results show a statistically significant improvement in patient pain scores at 1, 2 and 5 minutes following administration of methoxyflurane. With its use increasing in prehospital care and emergency departments, methoxyflurane is recognised as a useful adjunct to the choice of analgesia for trauma patients with moderate-to-severe pain.

A tactical analgesic option for Durham and Cleveland police firearms medics: the journey

February 2019

Background:With an ever-increasing exposure to clinical situations, predominantly trauma, firearms medics at Durham and Cleveland police forces began to consider whether an increase in their scope of practice was needed; specifically, whether they could add analgesia administration to their clinical protocols.Considerations:The request was directed to the Tactical Medical Advisory Group (TMAG). This faculty comprises a clinical lead, emergency medicine doctors, military and civilian paramedics and tactical team medic (TTM) trainers. Analgesia in general was discussed, then potential analgesic agents were considered. The faculty agreed that the analgesic agent would have: to be available to all tactical team medics at all times, so should be highly portable); a minimal regulatory and training burden; a rapid effect with minimal side effects; and no conflict with prehospital medicine practice.Implementation:A 6-hour training course in methoxyflurane (Penthrox®) with summative assessments was designed and delivered by TMAG to all TTMs over a 4-week period. The chair of the TMAG agreed to be the signatory for the prescription-only medicine document and a standard operating procedure was drawn up. Sufficient stocks of methoxyflurane were then purchased and distributed across both police forces' armed response units, together with updated patient report forms, administration documents and feedback forms completed by TTMs after incidents.

Human factors in student paramedic practice

January 2019

Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. A personal experience as a student paramedic highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated. Discussions regarding human factors that influence a student paramedic's development on practice placements remain in their infancy. The student paramedic role is unique and challenging, and involves developing a level of resilience that continues post registration. Because of the role's emotive nature, students need to increase their awareness and management of human factors to prevent them from affecting their practice. Equally, educators need to have a greater focus on encouraging and teaching coping strategies. Practitioners who work with students do so whether they choose to be a mentor or not and many may feel unprepared for the role. Interactions between students and clinician mentors are complicated and future research will be required to determine the best approach to aid student development in the placement environment.

Examining the benefits of paramedic engagement for the novice researcher

December 2018

Background:Paramedics new to research need to know how to optimise the quality of proposed research studies. A prehospital mixed-methods study design required guidance, not only from an academic perspective but also from experts within paramedicine. Paramedic engagement was defined as an exercise where paramedic researchers and paramedic clinical academics could be involved as advisory professionals.Aim:The aim of this paramedic engagement was the revision of a proposed research design on how senior clinical advisers determine futility in pulseless electrical activity in out-of-hospital cardiac arrest.Method:Five research paramedics and four clinical academics were interviewed by email using semi-structured questions. A generic qualitative inquiry with inductive content analysis was applied.Results:Paramedic engagement identified five themes: rewording the proposed study title; acknowledging that paramedics withdrew resuscitation; the implications of prolonged futile resuscitation; the need for autonomous paramedic decision-making; and improving research methodology.Conclusions:Professional paramedic engagement meant a number of complexities were identified within prehospital research and and pragmatic solutions were provided to the limitations in the proposed design. Novice researchers within paramedicine would benefit from early paramedic engagement to facilitate the design of research studies, provide guidance on methodology and identify limitations to improve the overall quality of prehospital research proposals.

A qualitative exploration of current paramedic cardiac auscultation practices

September 2018

This exploratory study addresses the current paucity of knowledge available in UK paramedic practice in relation to cardiac auscultation. There is a recognised lack of data surrounding the efficacy, safety and relevance of patient assessment skills in the pre-hospital setting in general, and cardiac auscultation specifically. This study provides information about current paramedic practice, and provides a basis for further research in this area. An online survey was distributed using convenience and snowball sampling, receiving 328 responses within a 31-day period. The results show that many paramedics rarely, or indeed never, undertake cardiac auscultation and that many lack confidence in recognising normal and abnormal heart sounds. There is also a divided opinion among respondents who provided free-text answers, with some feeling that the skill of cardiac auscultation is vital in pre-hospital care and others firmly disagreeing. This research lays the groundwork for further developments in training, education and continuing professional development for paramedics.

Leadership in training: a Q&A with Ian Corrie

February 2019

As well as the use of practical clinical scenarios, the training weekend was also used to provide leadership and development training for senior members of the regiment. In this special Question and Answer feature, the man in charge, Ian Corrie, provides a more in-depth insight into what the training involved

A Guide to the Mental Capacity Act for Paramedics

October 2018

The Mental Capacity Act 2005 is one of the key pieces of statutory legislation used in modern paramedic practice. To the unprepared, the Act can seem complex and daunting; but it is a powerful tool which helps paramedics to deal with often complex and challenging situations in a way which is both ethically and legally safe. What follows is a walk-through of the Act itself looking at the parts which are relevant to paramedic practice and discussing issues relating to them which, it is hoped, will enable paramedics and others involved in delivering pre-hospital emergency medical care to apply the Act with confidence in their practice.

Breaking bad news and managing family during an out-of-hospital cardiac arrest

July 2018

The management of family during out-of-hospital cardiac arrests and death notification to the family of the deceased in the out-of-hospital setting are topics that are poorly evidenced. Two focus groups consisting of six participants in each were conducted, discussing the two subjects. The results suggest that paramedics prefer family not to be present in the room for a number of reasons and that they don't feel sufficiently trained by their paramedic courses in order to manage family during resuscitation or breaking bad news. The study highlighted a need for more research on both subjects.

Care pathways for low-risk transient ischaemic attack

June 2018

Background:In secondary care, the urgency of review for transient ischaemic attack (TIA) has relied upon the use of the ABCD2 score, but this tool is not validated for use by emergency ambulance crews. There is a need to evaluate alternative care pathways for patients who might be eligible for direct referral to TIA clinics without prior conveyance to the emergency department (ED).Aim:The aim of this national survey was to describe current service provision across the UK for pre-hospital emergency care of patients with TIA.Methods:The authors approached all UK Ambulance trusts (n=13) by email, asking them to provide details of TIA patient referral pathways.Findings:Twelve ambulance services responded to the survey and nine reported that they had no current pathway; one had discontinued a pathway because of service reconfiguration; and three were currently using one. All pathways used the ABCD2 tool to screen patients and classified patients as low-risk if the ABCD2 score was 3 or below. Non-conveyance exclusion criteria varied. Although compliance with referral pathways was audited in an initial pilot in one service, no other evaluations of the effectiveness of pathways were reported.Conclusion:A minority of UK ambulance services report introducing referral pathways for low-risk TIA patients, avoiding initial assessment in the ED. Safety, effectiveness and acceptability of such pathways have not been evaluated to date.

Medical negligence insurance for paramedic professionals

Medical negligence insuranceThe cover is generally described as Medical Malpractice insurance—but can often be referred to as Medical Liability insurance, Medical Indemnity, Clinical Negligence cover or Professional Indemnity. Its overriding objective is to insure the health professional against claims arising from wrongful advice or negligent treatment.

Does precedence trump in the origins of confidentiality?

Good clinical practice has to be entwined with good ethical practice. Therefore, it follows that the clinical acumen of a modern paramedic develops at the same rate as their moral and ethical practice. As a newer profession, paramedics have relied on rules and codes from others to help maintain this balance, but their ancient and basic structure fails to address the nuances of modern practice. The paramedic profession has required a heuristic approach, as well as relying on the precedent of modern laws and codes, to underpin practice while simultaneously recognising the limitations of oath-based principles. This response has been necessary to address the increasingly complex and complicated situations paramedics encounter in their clinical environment.

The only practical CPD journal for paramedics

About Journal of Paramedic Practice

Latest CPD

Most read

Comment

What our readers say

Clinical practice

Research

Education

Leadership and management

Legal

Keep up to date with Journal of Paramedic Practice!