Volume 10 Issue 3

Labelling and care: what's in a name?

Sometimes when I say I'm an editor, the assumption is that I'm nothing more than a human spell check. I can spell, yes—but that is only a minute aspect of an editor's role. I won't delve into my 9–5 here; but I want to hone in on one part of my job that I feel quite strongly about.

Pulse oximetry: SpO2 and SaO2

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, Barry Matthews explores the history and significance of pre-hospital use of the pulse oximeter.

The National Ambulance LGBT Network Conference 2017

In 2015, the National Ambulance Lesbian Gay Bisexual and Transgender (LGBT) Network was founded to help improve the experiences of LGBT people who contact the ambulance service; expand the support offered to ambulance staff; and create a visible presence in the community. Since its formation, committee members, regional representatives and ambulance staff from across the country have worked tirelessly towards these core objectives, and to share best practice between regional ambulance LGBT networks. In August of 2017, the Network held its second annual conference to emphasise some of the health inequalities that LGBT people are known to experience when accessing health care. Over the course of the day, delegates were able to learn about interventions and support measures that are available through a series of workshops on issues such as dementia care and post-traumatic stress disorder. This conference report documents the success of the National Ambulance LGBT Network Conference 2017 and provides an overview of the engagement and support packages that are currently under development to support staff wellbeing and patient experience.

Applicable scales for use in the pre-hospital setting

Three Key TakeawaysMost ambulance services are promoting mental health and wellbeing within their workforce, who are themselves increasingly attending incidences of mental health presenting patients; therefore, the book may have a high degree of relevance to the practising clinicianThe text doesn't necessarily make for easy reading—it is littered heavily with academic references and numerical data. Having said that, it is also packed with valuable information which provides a good insight into specifics of each measurement scaleEach scale is explained and broken down into the methods of scoring, validity and reliability. However, it is the short introduction preceding these which you find the most useful


What are paramedics tweeting about?Paramedic Practice @Para_PracticePhone line 111 planned for full roll-out by 2020 in #Wales in an effort to ease pressures on the #NHS, particularly on frontline services by freeing up #ambulances. Do you think systems like this could be the future for the NHS across the UK?@PN_FitzIt adds to our workload …. far less reduce it! NHS 111 or NHS 24 in Scotland. An Increasing demand where more of these calls are suited to other clinicians & pathways.Don't know about Wales ….@digitalparamedQuite anecdotal view. Can't speak for #NHS24 (111 Scotland) but the data for #NHS111 (England) doesn't support that.Around ~79% of 111 calls are triaged to primary and self care.Tasha Starkey @WMASTStarkeyWe can remove a note and move on with our day but verbal or physical abuse should NEVER be tolerated. Which is why the crew were so upset/angry. Stopping to have a go at us delays us leaving for hospital AND causing you to wait longer for us to move‥ thanks @StaffsPoliceRob Marsh @wmasrobmarshOff to check on one of my team who got bitten by a patient yesterday!! Yes bitten. Broke the skin, antibiotics and all sorts… it gets worse and worse #teethmarks#howisthatokRob Moore @wmasrobmooreHow clever is this? On our electronic patient record, if we're entering details for a child patient and head over to the “Guidelines” section, it automatically selects the @AACE_ org guidelines relevant to that age of patient, including normal observations & drug doses! #paramedicAmy Kyle @amy_kyleDid my first tube as a Paramedic this week at my first cardiac arrest as a qualified clinician. I then also proceeded to do my first extubation when the ROSC lead to good respiratory effort, awareness and the patient gagging & localising to the tube!

My first placement and being out on the road

The third instalment of our student column sees Ellie Daubney recall her first placement and reflect on how important being on the road in the pre-hospital environment is to paramedic study.

Pre-hospital management of major haemorrhage following trauma: part one

Major haemorrhage remains the highest preventable cause of death following trauma, accounting for 30–40% of trauma mortality (Kauvar et al, 2006). Therefore, pre-hospital intervention is a key aspect of paramedic practice. Paramedics are often first on the scene and have a range of local and systemic treatment options. Pre-hospital medical advances, such as the introduction of tranexamic acid, allow paramedics to deliver a higher standard of care. In addition, the number of patients on anticoagulants and antiplatelet drugs is increasing; therefore, knowledge of how these drugs interact with the haemostatic response would be beneficial. It is important that paramedics fully understand the mechanisms of drugs interacting with the haemostatic response, and the theory underpinning the management of major haemorrhage (Kreuziger et al, 2012). This enables paramedics to understand why they are administering the care they are providing. This article gives a detailed overview of two physiological responses to major haemorrhage: haemostasis and blood pressure. This is followed by an explanation of how these systems are deranged and altered by major haemorrhage through pathophysiological consequences. Finally, recent research covering advances in the understanding of how deranged coagulation occurs is also discussed.

Safe transfer of simulation-based intubation skills to patients in cardiac arrest

Background:Studies investigating the transfer of endotracheal intubation skills from simulation training to out-of-hospital patient scenarios are limited.Aims:The aim was to evaluate the outcome of endotracheal intubation simulation training among paramedics and the safe transfer of skills to out-of-hospital cardiac arrest (OHCA) patients.Methods:Paramedics participated in a 1-day simulation training course including five Airtraq endotracheal intubation attempts using three different types of mannequins (n=15 attempts). Performance and outcome of transfer of intubation skills to patients were monitored for the next 35 months. European Resuscitation Council international advanced cardiopulmonary resuscitation guidelines (Nolan et al, 2005) were followed to ensure patient safety.Findings:Endotracheal intubation was attempted in a total of 417 patients with OHCA by 51 (96%) of the 53 participating paramedics. In 366 (88%) patients, intubation was successfully performed in the first or second attempt. Aspiration, airway secretion, a high modified Cormack Lehane score and insecure verification of tube placement were the most common reasons for failed intubation.Conclusion:Endotracheal intubation with Airtraq in adult patients with OHCA can be performed safely by paramedics after receiving a 1-day simulation-based training course.

Inequalities faced by LGBT patients and staff must end

In this article, Alistair Quaile examines the healthcare inequalties faced by lesbian, gay, bisexual and transgender patients and staff, and discusses developments being made by ambulance services to address these problems.

Smaller, lighter, faster? Reducing the carbon footprint of ambulances

This paper outlines a feasibility project investigating the potential for smaller, lighter rapid response vehicles (RRVs) in reducing the carbon footprint and response times of ambulances. Five stakeholder consultations were held with two ambulance trusts, an ambulance manufacturer, a paramedic and the Ultra-Light Vehicle Group to generate three novel design concepts for RRVs, which were then reviewed by four UK fleet managers and four clinicians. The results indicated that the integrated clinician service model could create a future market for smaller, lighter vehicles. Reducing carbon emissions in the short term will most likely be achieved using lower emission engines and improving engine and power management for dual-crewed ambulances. In the medium term (5–10 years), there will be a demand for low emission, composite light-weight dual-crewed ambulances.

Continuing Professional Development: Pain management in children in the pre-hospital environment

OverviewPain management is complex in children; age, developmental level, and both cognitive and communication skills, as well as associated beliefs must be considered. Pain can have psychological, physical and social consequences, all of which impact quality of life. Without effective pain treatment, there are risks of long-term changes in stress hormone responses, pain perception and post-traumatic stress disorder. The current article helps to shed light on a number of difficulties faced when managing pain in children, and how to overcome them.

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