Gray and Walker explore the potential for employing a more appropriate mechanism of clinically focused dispatch to ensure the most effective tasking of emergency care practitioners (ECPs). The study focuses on the Yorkshire Ambulance Service which has ECPs in three localities as well as in the communications centre.
Joanne Fisher, Simon Brown and Matthew Cooke, on behalf of the Joint Royal Colleges Ambulance Liaison Committee Guideline Development Group, set out the position of the group
College of Paramedics (British Paramedic Association) updated position paper following Joint Royal College Ambulance Liaison Committee (JRCALC) recommendations on paramedic intubation
Roland Furber reflects on the evolution of the paramedic profession and the place of this journal in the wider picture of professional development and self-regulation
Welcome to the first edition of the Journal of Paramedic Practice. It is exciting to launch this journal at a time when it is essential to support the professional development of the paramedic, with so many changes in recent years such as a move towards an academic framework for the role, Agenda for Change and Call Connect.
Rapid sequence induction (RSI) is one of the key additional skills that an appropriately-trained doctor can bring to the prehospital environment. Controversy remains over the most appropriate person to perform RSI.AimsTo review the scope of RSI activity on one helicopter emergency medical service (HEMS) unit and assess paramedic involvement and leadership in delivering prehospital RSI.MethodsProspective review of clinical database for air ambulance serviceResultsCrews performed 72 RSIs over a 13-month period. Paramedics intubated 47 patients (65%). None of the intubations performed by paramedics required any intervention by the doctor. Of the RSIs 55 (76%) were performed on trauma patients and 17 (24%) for patients with medical emergencies; 31 (43%) were carried out in the presence of emergency physicians, 30 (42%) with anaesthetists present and 11 (15%) with a surgical specialist registrar. One doctor (consultant emergency physician) was present at RSIs on two patients at one scene; the paramedic intubated one of the patients. Six adverse events were reported. There were no reported serious technical complications of the RSI procedure such as incorrect tube placement or oxygen desaturation.ConclusionsOur experience supports the growing recognition that appropriately-trained non-anaesthetists can perform RSI as safely as anaesthetists in both the hospital and prehospital environments. Our study also suggests that with appropriate training and supervision, paramedics carry no greater risks in RSI than their anaesthetic and non-anaesthetic medical colleagues.
Recent guidelines for paramedic intubation have been published by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) (2008). One important recommendation for paramedic intubation is that: ‘When prehospital tracheal intubation is undertaken, a gum elastic bougie should be available routinely’.Despite this, the bougie has not been universally available among ambulance services in the UK—up to a third do not include the bougie as part of their airway management strategy.We aim to introduce the bougie, provide information on its use, advantages and pitfalls, and provide some tips as to how to get the most out of this invaluable device in clinical practice.
This is a small pocket guide written by a pair of eminent doctors with a clear market for other doctors who want to be more involved in the ‘sexy’ world of pre- and out-of-hospital care.
This article provides an overview of how to read and review a journal article for a range of purposes. Articles are read for a variety of reasons, such as to support the review of a specific subject area, for a research study or academic research. Reading articles on a regular basis will not only improve your academic reading skills but also will begin to develop your skills in critical analysis of journal articles and their application to practice.A breakdown is provided of different aspects of an article with some suggested questions to ask in order to ensure that you get the most from the article. Several types of journal article are outlined, including case studies, literature reviews and research articles. Also highlighted are some of the pitfalls when reading articles and suggestions for ways to develop confidence in critical reading and share expertise and experience to inform clinical practice.
Chris Knox discusses the role of the paramedic in the custody care system, together with his personal experience of the work.
Kath Start reflects on the changing face of education for practitioners in prehospital emergency and unscheduled care
This article is intended to provide an overview of the historical, current and future trends in paramedic education.Over the past 15 years, the training and education of technicians and paramedics has seen a shift from the more traditional approach initiated by the Institute of Health Care Development (IHCD) towards an academic route developed in association with Higher Education Institutes (HEIs). This shift reflects the curriculum framework put forward by the British Paramedic Association (BPA) which acts as an educational basis for future paramedic education. The framework does not exist in isolation and is influenced by the Health Professions Council's (HPC) Standards of Proficiency (2007) and Standards of Education and Training (2006) and the Quality Assurance Agency (QAA) Benchmarking Statements (2004). This BPA framework represents new ways of working for paramedics and technicians as front line practitioners. Essential transition from training to education is viewed as key for the future of ambulance service delivery. This paper endeavours to ask the question: Higher education for paramedics—why?