Risk and benefits of paramedic-initiated shoulder reduction

The introduction of prehospital reduction of shoulder dislocation by paramedics is a huge departure from previous teachings. Although shoulder reduction is recommended for use in specific circumstances, such as wilderness areas, little published evidence exists either to provide a solid foundation for its prehospital use, or advise against the introduction of this procedure. Shoulder dislocations, while affecting a minority of the community, are painful and debilitating and require early reduction, as muscle spasm increases with time, making reduction more difficult. In areas associated with prolonged ambulance transport times, the delay to definitive treatment may cause needless pain and suffering to patients sustaining shoulder dislocation. In order to assess the risks and benefits of paramedic reduction of shoulder dislocation, this study systematically evaluated the available evidence. No evidence from clinical studies in the prehospital setting was found: studies from other health settings are used to synthesize recommendations for paramedic practice that enable timely, safe and humanitarian care of patients with shoulder dislocation.

Heliox in acute severe asthma in the A&E setting: a review

Heliox (HeO2) is a mixture of helium and oxygen, often mixed in 80:20 or 70:30 ratios for use in medicine and clinical investigations. Heliox has been available for use in the UK since 2002 and is supplied as Heliox 21 (21% oxygen and 79% helium) by BOC Gases for medical use in asthma, croup, chronic obstructive pulmonary disease and other medical procedures. Heliox use in asthma exacerbations remains largely experimental owing to the limited number of randomized controlled trials. This review aims to critically analyse the efficiency of Heliox use in acute asthma exacerbations in the Accident and Emergency (A&E) setting, evaluate its effectiveness as a medium for nebulization, and assess potential benefits to clinical practice. Prehospital application will also be discussed in moderate-severe asthma exacerbations. It is envisaged that the factors relating to Heliox use in asthma are focused to provide an additional therapy to the current choice of therapies for prehospital clinicians.

CPD: are you ready?

Since 1 July 2006, the Health Professions Council (HPC) has required that all registered health professionals undertake continuing professional development (CPD) as a legal requirement. The initial review of CPD took place in July 2008, with chiropodists and podiatrists being the first professions to be audited, followed by operating department practitioners. Paramedics will first be audited in June 2009. CPD is linked to maintaining your registered status and is the hallmark of a self‑regulating profession. Failure to complete CPD without good reason could mean that a paramedic is refused renewal of his/her registration.

Championing your pursuit of best practice

As publisher of the Journal of Paramedic Practice (JPP), may I begin with a big thank you to our subscribers for your support of this new publication. JPP is our response to heartfelt representations from the UK's most prominent paramedics expressing the urgent need for a paramedic journal that encompasses clinical, professional and research issues in a serious but accessible way.

Looking towards a model of advanced practice in the UK

The agenda for ambulance service provision in the UK has developed rapidly over previous years, with a focus on role redesign and development to improve access to health care and service provision for patients. This blurring of traditional boundaries has empowered healthcare practitioners to adapt and take on responsibilities that challenge pre-existing roles. The emergent role of the advanced practitioner has been recently established in the nursing field however, within ambulance services it is very much in its infancy. This article will discuss and analyse the role of the advanced practitioner, looking at theories and evidence to underpin advancing roles. While the focus of this piece is advanced practice in critical care, many of the concepts are strongly applicable to any advanced role with prehospital care.

Expecting the unexpected: emergency preparedness

Dealing with emergencies is all part of the job for ambulance staff, and putting strategies into place to cope with all eventualities is vital to provide an effective response in the face of a major incident. Mark Norbury, National Emergency Preparedness Coordinator for the Ambulance Service, explains.

Spotlight on research

This research examines whether it is more effective to shock a patient in cardiac arrest immediately, or whether it is better to carry out 3 minutes of cardiopulmonary resuscitation (CPR) before defibrillation. Over a period of 761 days, the South Australian Ambulance Service participated in a randomized control trial (RCT) that included 202 patients who were in ventricular fibrillation (VF) cardiac arrest. These patients were randomized into two groups: one group received immediate defibrillation (n=105); the other group received CPR first (n=97). Overall, 28 patients survived the arrest and were discharged from hospital. Eighteen of the surviving patients were defibrillated immediately, and 10 were given CPR first before defibrillation. Overall, the authors conclude that there is no benefit to delivering 3 minutes of CPR before first defibrillation in out-of-hospital VF cardiac arrest. In addition, an unexpected finding emerged from a major challenge encountered within this RCT. The resuscitation guidelines changed midway through the study, and this resulted in a change of clinical practice in the management of cardiac arrest, which clearly has to be considered in any interpretation of the results. Although the authors emphasize that their analysis of this change did not demonstrate statistical significance, they indicate that the data collected demonstrate a strong trend towards improved survival rates after the implementation of the new resuscitation guidelines.