Volume 10 Issue 5

Intraosseous access: a safe alternative route

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. In this issue, Kacper Sumera, discusses the benefits of intraosseous access as a safe alternative to intravascular access.

A glance at emergency care and a concise refresher

Three Key TakeawaysEach segment is illustrated with easily understandable and colourful diagrams, and tables with the most relevant information, which is great for quick referenceThe section on spinal control makes the salient point that spinal immobilisation is more important than clearing it, as sometimes too much pressure can be put on the necessity of clearing at sceneThis volume is likely to be well-received as a concise, well-thought-out reference that contains both up-to-date and emerging techniques

Clearing up a misstep on ambulance ‘misfuelings’

Last month, the Journal of Paramedic Practice shared a news story on its social media platforms published by the Telegraph on ambulance ‘misfuelings’, which garnered a heated response from our readers who noted that the numbers were misrepresented. Rebecca Gilroy seeks out context to present a clearer picture of the situation

Paramedic views on clinical research in cardiac arrest

Background:The success of pre-hospital research relies on positive engagement from paramedics. Without adequate participation and protocol compliance, trials will not succeed.Aims:The aims of the current research were to seek feedback from paramedics about trial participation and determine their views and preferences regarding a large-scale research study in future.Methods:Paramedics participating in REVIVE-Airways, a trial of airway management in out-of-hospital cardiac arrest, were sent a feedback questionnaire according to their study allocation.Findings:Of the total respondents, 99% were willing to participate in a further large-scale trial. Participants offered recommendations for future pre-hospital trials.Conclusion:There was strong support for further clinical trials of alternative airway management strategies during out-of-hospital cardiac arrest. Paramedics welcome opportunities to participate in research and receive feedback about trial progress and patient outcomes.

Why do paramedics have a high rate of self-referral?

Paramedics have been regulated in the UK since 2003. Analysis shows that the profession has had consistently higher rates of self-referral to its regulator compared with other health and care professions. Between 2013 and 2016, the percentage of paramedics who self-referred averaged 50% of all cases, compared with 6% across all other health professions regulated by the Health and Care Professions Council (HCPC) and 10% across social workers in England. This article reports on possible reasons underlying this trend. Using a mixed-methods approach including a literature review, interviews, focus groups and case analysis, the study identified a number of possible contributory factors. These included pressurised work environments, variable guidance and support from employers, and work cultures of fear and conflict. The evolving nature of the profession was also cited. The research found that there was a cohort of cases that appeared inappropriate—where the referral was for a matter that did not require reporting. Actions are being taken to reduce such self-referrals to avoid the emotional distress and resource implications for those involved.

Cooling of thermal burn injuries: a literature review

Correct initial management of thermal burns is key in promoting patient outcomes. Cooling burns with cool running water (CRW) for 20 minutes has been shown to accelerate the wound healing process, improve cosmetic outcomes and prevent burn progression. This literature review aims to increase understanding of this simple first aid (FA) intervention, help inform paramedic practice, and determine areas for further research. Three themes came to light following systematic searching of the available literature. As a result of a paucity in evidence, a wide range of topics relating to cooling burns have been explored. The topics look at how patients and carers may approach FA in burns, how pre-hospital practitioners currently manage burns patients, and the best methods to use for cooling burns. Findings suggest that there is need for improved education for the lay public and pre-hospital providers in order to improve burn outcomes through FA interventions. While CRW is supported as a beneficial intervention, further research is required into alternative cooling methods to enhance care and evidence-based practice.

Traumatic cardiac arrest: what's HOT and what's not

Traumatic cardiac arrest (TCA) is a rare event in the pre-hospital setting and has a varied aetiology. Paramedic management has changed significantly over the past 5 years. Chest compressions have been de-emphasised in guidelines, and the ‘HOT’ principles have been adopted. This principle stands for hypovolaemia; oxygenation; tension pneumothorax/tamponade. The recommendation is that these should be addressed prior to performing chest compressions. There may however be patient groups in TCA who benefit from chest compressions. A management plan including ‘no chest compressions’ for TCA is not supported in the evidence, and they should be commenced as soon as appropriate reversible causes have been addressed. In addition, chest compressions may take precedence over the administration of fluid if both cannot be performed simultaneously. Ambulance services may improve management of TCA by the introduction of an aide-memoire to support clinicians.

Mental health: caring for the paramedic workforce

In recognition of Mental Health Awareness Week taking place this month from 14–20 May, the Journal of Paramedic Practice's Rebecca Gilroy reports on the need for paramedic practitioners to recognise, be open about and begin addressing the inevitable impact of their work on their mental health and wellbeing.

Alterations to the HCPC threshold qualification level

Louise Shewey, from the Health and Care Professions Council, discusses changes to the threshold qualification level for entry to the Register for paramedics to degree level, and what it means for those currently on the register or those who are looking to join.

Connecting in a fog of anonymity

Do you ever feel like some members of the public don't see past your ambulance or your uniform? Like they can't see the person that you are, just working hard to do your job and live your life? When I hear stories of rude notes being left on ambulances or of people working in emergency services being mistreated, my initial reaction is to feel appalled that they don't appreciate the work you're doing to save lives in every community despite what a tough job you have. Then I get to thinking how ridulous people can be, and whether they have managed to somehow disconnect from the fact that you are actual people behind those uniforms and in the ambulances flying by us with sirens blaring.

JPP SoMe

What are paramedics tweeting about?Paramedic Practice @Para_PracticeRise in the number of physical and verbal sexual assaults on #ambulance staff according to figures from the #NHS Share your thoughts with us—how do you feel about this? What do you think needs to be done to better protect ambulance staff?@xGypsyJenxIf there's clinical cause eg UTI related confusion there is grace for these patients but not for those choosing to be abusive #zerotolerance@jason_whalleyI bet verbal assaults is massive. How many staff get sworn at each shift and don't report it!Craig Harman @CraigAHarmanDo you know these two chaps? One of our #Paramedics was assaulted from behind in an unprovoked attack. He sustained serious injuries including broken ribs, a broken eye socket and serious bruising. Please get in touch with @BTP if you have any information or RT.WMAS LGBT @wmasLGBTSo @wmasrobmoore has been talking about his #bluelighthappy campaign and how @OFFICIALWMAS has over 70 #CorporateTweeters who are able to engage with the community in a variety of ways…If you look closely you'll spot us on Rob's presentation! #GreatWork #SocialMediaImpactTom Mallinson @MallinsonTExcellent revision session from @DaveWCurrie on nauseogenic vestibular stimulation today. Thanks guys—it was still a great experience, invite me back anytime! (Until then I'll stay safe on the ground)Taj Hassan @RCEMpresidentRemarkable to see how similar our problems are Simon. Overcrowded hospitals leading to crowded EDs leading to added risk of patient harm & added risks to staff health. Our systems under resourced to cope #time2change #crowdingkills

Continuing Professional Development: Pulmonary embolism in pre-hospital care

OverviewPulmonary embolism (PE) is a potentially life-threatening disease, which presents with non-specific signs and symptoms. Evidence suggests that diagnosis is often made on post-mortem examination and misdiagnosis is likely. There are a number of pathophysiological processes that occur in acute PE, which have several systemic effects on the body and the compensatory mechanisms. A thorough understanding of these physiological processes and how these manifest, will afford the attending clinician a greater knowledge base on which to develop clinical reasoning skills, therefore initiating timely management and transportation to definitive care. Clinicians should also have an awareness of adjunctive therapies available in the management of PE, which include inotropic support for profound shock and thrombolytic therapy in cardiac arrest. This article explores the pathophysiology of the disease process, the identification and pre-hospital management of PE.

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