Volume 10 Issue 2

Expanding our contribution and shaping the future

Ian Peate consultant editor of the Journal of Paramedic Practice, shares his insight into what independent paramedic prescribing could bring to our practice and its benefits for both patients and practitioners alike.

Making prescribing a reality: the next steps in practice

What does the outcome from CHM mean?The recommendation made by the ad hoc group, and subsequent endorsement from the CHM, is the last major hurdle for the project in regards to influencing those who will ultimately advise government ministers on amendments to legislation. This means that we have successfully demonstrated that paramedic prescribing will be safe and appropriate, and will benefit patient care.However, rather than being seen as the end of the journey, this really only marks the start of the next leg. While the next phase is more predictable in terms of what needs to happen, it is less easy to predict when things will happen. You cannot complete a prescribing module with the hope that the law will change; and now that we know the law is very likely to change, there is a temptation to think this may expedite prescribing status.In reality, you can only become a prescriber after successfully completing a Health and Care Professionals Council (HCPC)-approved course once the law changes. This is because the annotation prescribers are given by the HCPC (2013) is the legal authority to prescribe and is only granted after completing a profession-specific approved training course and gaining a qualification.From this point, NHS England will work with the Department of Health and Social Care (DHSC) to make a submission to ministers requesting amendments to the Human Medicines Regulations (HMR) (2012), along with other consequential amendments to regulations that will be required to fully implement independent prescribing by paramedics. Of the many NHS Regulations, amendments must be made to the following:General Medical Services Contracts (NHS England, 2015a)Personal Medical Services Agreement (NHS England, 2015b)Charges for Drugs and Appliances (NHS England, 2015c)Pharmaceutical and Local Pharmaceutical Services (NHS England, 2013).There will also be further work with NHS England and the Home Office to consider the proposal for paramedic independent prescribers to be able to prescribe from the restricted list of six controlled drugs, which would require amendment of the Misuse of Drugs Regulations (Home Office, 2001). This is the same process for paramedics as it was for other professions achieving prescribing status previously. There are only two opportunities each year to recommend change to legislation—Easter and Autumn—and it is not certain whether we will see amendments to the HMR made early in 2018. While we cannot guarantee this, we hope that the amendments to the legislation happen earlier in the year.Alongside these goals, the College of Paramedics will continue to work in partnership with NHS England on key documents needed to support implementation, such as Practice Guidance and the Implementation Guide—the latter includes a self-assessment matrix for aspirant prescribers. These two documents will be published on the College website in due course. The other document is the Outline Curriculum Framework (Allied Health Professionals Federation; 2017) for allied health professional (AHP) prescribers. This document will be amended by the College with the support of NHS England, but it is owned by the Allied Health Professions Federations, who will publish this document on their website.Rather than being seen as the end of the journey, this really only marks the start of the next legADOBESTOCK/BORPHLOYThere is still lots of work to do, such as engaging with patient and public groups, universities, other professional bodies, the Association of Prescribers, and employers, among others, and we hope to be able to give more news on potential timescales on progress towards course enrolment dates as soon as possible.

Having to hit the ground running

The second instalment of our student column sees Abbygail Elsey recalling first-year hurdles and reflecting on how to make the most of opportunities given—no matter how unprepared you feel.

Integrating aged care in the curriculum: the importance of design and evaluation

Background:The current study describes the design and implementation of a residential aged care facility placement, and reports student experiences using an attitudinal survey across two cohorts.Method:Placements in January 2014 and 2015 were surveyed to identify barriers and enablers to student learning. Descriptive analysis was used to report the frequency of responses for categorical variables. Chi-square tests were used to analyse change in item rank by year. Content analysis was used to analyse text responses.Results:Initial 2014 results show that 75.4% of respondents agreed that they were able to achieve the required learning outcomes during this placement, with 72.8% agreeing that the placement improved their knowledge of community-based care for the elderly. Students tended to agree that the placement improved their confidence as practitioners, and that the experience helped to improve communication skills.Conclusion:This initiative showed that it is possible to enable learning outcomes that are directly related to core paramedic competencies. The placement was associated with improved understanding of age-related health problems. In addition, the placement provided opportunities to observe the role of health professionals in the maintenance of an older individual's health, social and spiritual needs.

So much more than an ambulance driver

Last month, I shared with you the moment when my 5-year-old daughter went from wanting to be a butterfly to wanting to be part of the ambulance services—a moment of pride to be sure (although, who doesn't love butterflies?). Funnily enough though, the next day she decided she wanted to be a doctor, and that her 1-year-old baby brother would be a nurse. In response to this, my husband said, ‘oh you're going to be the doctor, and your baby brother is going to be your assistant?’

Peak expiratory flow rate

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontlines, highlighting the importance of these skills and how to perform them. In this issue, Andrew Kirk discusses peak expiratory flow rates and the management of asthma patients in pre-hospital care.


What are paramedics tweeting about?Paramedic Practice @Para_PracticeVia Guardian politics live, Theresa May is facing more criticism for #NHS struggles despite NHS England dismissing talk of ‘crisis’ and claiming they are better prepared for #winter than ever: ‘in a way that we've never prepared before’@Kev1211Not in crisis?? Maybe not at the local Pvt hospital@tonyj154The question is why have more ambo staff left in the last 5 years more than any other period in the NHS history… I'm one of them!They recruit uni bods that are taking years to get qualified.. then they leave!@scott_goudieWell if you bury your head in the sand and ignore it it'll go away right? #dillusional [sic] #SaveOurNHSSam Grimson @wmassamgrimsonLast night was probably one of the worst I have experienced for inappropriate use of the Ambulance service.15 patients attended.1 taken to Maternity unit.The rest either treated on scene or just wanted a “check up” or weren't there when we arrived or were hoax calls!Rob Etall-Paramedic @robetallIt's refreshing in these incredible times in the #NHS the unwavering support that the public bestow onto usIt's truly inspiring to see/experience The pressures are obvious + issues complex, but #NHSWorkers are working very hard to keep u all safe. Thank you! #WinterPressuresKirsty Smith @kirsty_e_smith1Practising paediatric and adult ALS scenarios in @NWAmbulance mandatory training to make sure we're slick when on the real thing #pitstopresuscitationBen Hooper @BenrhooperI am not a huge fan of ‘live tweeting’ but if you are, be careful of what you tweet! It might be helpful using this chart found in the @Para_Practice Journal of Paramedic Practice #tweetappropriately #LiveTweeting

A handy edition you'll find yourself dipping into

Oliver Phipps and Jason Lugg's Rapid Emergency and Unscheduled Care describes itself as a ‘revision pocket book that covers the key facts in a simple and memorable way’. It is mainly targeted at less experienced healthcare staff, such as students and the newly qualified. It will also be of some use to those with slightly more experience.

Defibrillation: standard vs. double sequential in adult out-of-hospital cardiac arrest

Background:Refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest (OHCA) poses a significant challenge to paramedic teams and is further confounded by an absence of specific guidance on the management of this patient category.Objective:To conduct a systematic literature review to determine whether double sequential defibrillation (DSD) improves patient outcomes in adult OHCA.Methods:Electronic searches of CINAHL, MEDLINE and AMED databases were carried out, using EBSCOhost (2017) and a subsequent filtering process.Results:Three case series and two cohort studies provided the highest category of evidence to evaluate. DSD is offered as a potentially feasible RVF treatment strategy throughout. However, results are consistently limited by varying protocol and small study groups and DSD success is likely multifactorial.Conclusion:The current systematic literature review indicated that no confirmed association existed between DSD and improved OHCA outcomes. More robust research is required to eliminate profound limitations and consider contributing factors to DSD.

Continuing Professional Development: The role of the paramedic in sepsis management

OverviewSepsis is a potentially life-threatening complication of an infection and involves a complex array of inflammatory responses. Sepsis is usually caused by bacterial, viral, or fungal infections that are likely to develop into pneumonia, abdominal infections and kidney infections. Sepsis has gained increasing publicity in recent years and is now a strong focus of clinical education following the launch of the ‘Surviving Sepsis’ campaign. Paramedics need to understand the pathophysiological process associated with sepsis, and how these may present in patients.

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