Intranasal naloxone: not to be sniffed at!

Treating patients with an opioid overdose is not uncommon in prehospital settings, with naloxone being the drug of choice to reverse effects of opioid toxicity.

The role of the paramedic in health promotion

‘The role of the paramedic in health education’, is a subject area identified in the College of Paramedics Paramedic Curriculum Guidance and Competence Framework (College of Paramedics, 2007). There is no specific guidance on the content or context of this particular subject; therefore student paramedics and paramedic lecturers have interpreted this and linked it to health topics seen as relevant to young people. It is known that people can die for want of first-aid and that many people do not know how to perform first-aid. Two innovative 1-hour workshops have been designed for delivery to secondary school children in which the topic of emergency first-aid is linked with knife crime and drug and alcohol abuse. This article describes the rationale and design of the programme and reports on its initial feedback. It is a programme that shows great promise, but will require further evaluation before it can be rolled-out further.

Prehospital pleural decompression: a new way? : a new approach

Needle thoracocentesis is the current UK ambulance services sole method of pleural decompression in suspected tension pneumothorax; however, the effectiveness of this procedure is questionable. This article will discuss the viability of an alternative method of pleural decompression—tube thoracostomy—providing comparisons to needle decompression and other current techniques used in prehospital care. The efficacy and safety of available techniques will be critically analysed and recommendations for the assessment and management of tension pneumothorax will be provided.

Acute cocaine toxicity: assessment and cardiac risk

The UK has the highest prevalence of drug use within Europe, with a 13% increase in cocaine and ecstasy related deaths reported between 2004 and 2005. This is significant to emergency medical personnel because cocaine toxicity can present clinically as acute coronary syndrome (ACS) minus typical associated risk factors. Cocaine use has an immediate effect on the body, having an onset of action seconds to minutes after administration. The resultant effect is manyfold, but can be divided into the two broad categories of central nervous system and cardiovascular effects. Cocaine misuse is a trigger of ACS, acute myocardial infarction and sudden death in a population of patients largely free of classic cardiovascular risk factors. Emergency medical staff are in a position to provide early and effective management through history-taking and assessment tools in conjunction with therapeutic intervention. The aim of this article is to highlight the presentation and consequence of acute cocaine toxicity in relation to its assessment, management and cardiac emergencies within the prehospital setting.

Choosing the right evidence resource

Much of current health care delivery is based on evidence. The term evidence-based practice (EBP) has become synonymous with quality in the UK, with the ambulance service and the delivery of prehospital and urgent care being no different.

Diagnosing urinary tract infections: an overview

As ambulance services start to develop the role of the emergency care practitioner (ECP), ambulance crews need to understand the types of conditions that can now be referred to and treated by this new group of clinicians. This article sets out to demonstrate how ECPs can assist crews who are concerned that a patient may have a urinary tract infection (UTI), by highlighting the anatomy and physiology of the urinary tract, looking at the common causes of UTIs, showing how a practitioner would formulate a diagnosis and setting out current best treatment options. The article hope to show that by making informed referrals to ECPs the full benefit of the role can be achieved, ensuring best care to the patient who calls upon their skills.