Spotlight on Research

Cooper and Grant (2009) focus on the changing shape of out-of-hospital urgent care services by examining the international literature to establish which roles have evolved, what the scope of these roles are, and how they contribute to health care provision. The initial literature search returned 268 articles related to new or emerging roles in unscheduled, urgent care. After application of specific inclusion/exclusion criteria, 34 papers were identified as eligible for inclusion within this review. These fell into three categories: aspects of general role development; the emergency care practitioner (ECP) role; and the paramedic practitioner (PP) role. Although these studies were conducted in different contexts and locations, concerns about the expanding scope of practice for paramedics and emergency medical technicians, and the debate as to how best to educate and prepare these practitioners appear to be recurrent themes. Evidence indicates that the two new roles of ECP and PP appear to be linked to high levels of patient satisfaction; a reduction in unnecessary conveyance of patients to emergency departments; and increased utilisation of appropriate referral pathways. However, in all of these studies patient safety issues remain paramount, and the authors recommend that ongoing research and evaluation will be required to fully understand the impact and outcomes of the changes and role developments within out-of-hospital emergency care.

Leading the way in clinical effectiveness

The Bradley Report heralded a fundamental change in the operation of the ambulance services and one of its main objectives was to improve clinical leadership. Here, we learn about the man charged with delivering these improvements and the initiatives that he has spearheaded in the East Midlands Ambulance Service and beyond.

Update on healthcare-associated infections

Healthcare-associated infections (HCAIs) receive much attention and often receive much media coverage which can cause much political and public alarm. This article provides an update in relation to HCAIs and will serve as an introduction to a forthcoming series of articles in infection prevention and control. It is acknowledged that not all infections are preventable but managing infection control and ensuring best practice can improve patient outcomes significantly and enhance service user safety, as well as individual practitioner safety. Four areas of paramedic practice are addressed with the intention of reviewing current practice.

Overview of management of minor head injuries

Head injuries are very common and paramedics will therefore see many patients with head injuries. Most of these patients will not require any specific treatment. The challenge for pre-hospital and hospital carers is to identify the small minority of patients in whom a computed tomography scan is required and to expedite safe transfer to a neurosurgical unit for those very few that require specialist intervention. The key to identifying these is a broad understanding of the anatomy and pathophysiology of head injuries and also learning the important features of assessment and examination.

Recording a standard 12-lead ECG: filling in gaps in knowledge

Electrocardiography is a routine clinical examination performed by a wide range of health care staff. and is a core skill for paramedics. Guidelines exist in relation to the performance of this technique but may not always be adhered to. This article addresses possible reasons why ECG accuracy is declining and focuses on some common gaps in practitioner knowledge to improve understanding and practice.

Taking control of our future

The 20th April 2009 was an important but disappointing day for the paramedic profession, important in that it was the Annual General Meeting (AGM) of the College of Paramedics, disappointing that too few paramedic members turned up to make the meeting quorate. This meant that though the meeting continued, according to the regulations of the organization there were insufficient members to vote on the key decisions. Only 30 full members (around 1% of the College's paramedic membership) were required to attend the meeting but this figure was not achieved.