Working with them all

In this instalment of our student column, Ellie Daubney explains the benefits of working with a variety of clinicians while on placement and how this has helped shape her professional goals.

Toronto van attack response: Q&A with Toronto paramedics

Just over 2 weeks after the Broncos crash, Canada was hit with yet another horrific tragedy. A man driving a van mowed down pedestrians at a busy intersection in Toronto, killing 10 people and injuring 13. Toronto Paramedic Services quickly turned a nearby boardroom into a command centre and share their experience in this Q&A.

A paramedic's story of the Humboldt Broncos bus crash

On Friday 6th April, a semi-trailer truck collided with a coach bus carrying a junior hockey team and support staff, killing 16 and injuring 13, in Saskatchewan Canada. The accident devastated the country and drew international support. In this personal reflection, paramedic Jessica Brost shares her story of responding to the crash.

A look at discussions on JPP's social media

What are paramedics tweeting about?WMAS Ambulance LGBT @wmasLGBTAs a proud member of the @NatAmbLGBTUK it's fantastic to hear that they have been nominated for a #NationalDiversityAward for the development of the network; please support them and us by heading over to @ndawards and voting before 01 June! #Recognition #NDA18 #LGBTDebbie Johnson @DebbieJ_YasLovely to meet CFRs @CharKClarke and @Maddie111G from @HullYorkMed at an incident this evening. Keep up the fab work @YorksAmbulance #AlwaysLearningStuart Elms @elmsy1664As a Londoner I am so happy and proud to have heard from Dr Fenella Wrigley at tonight's @GoodSamApp event that @Ldn_Ambulance have received this result from their CQC inspection. Well done all. #team999Steve Pawley @stevepawleyReady to start training for the #Bristol HalfMarathon to raise funds for @GWAAC got @TheResusRoom on the iPod so I'm set!SEM Nicholas Jones @EEAST_EOCSEMToday has been all about progressing technology 4 staff and patients 06:00 ProQA upgrade and CAD failover testing then this evening meeting with @GoodSamApp, preparing for integration #TechnologyHelpsSaveLives #patientcare @EastEnglandAmb @EEAST_GMorgan @EEAST_KBrown @EEASTCEOEEAST Ambulance @EastEnglandAmbWell done to our four student #paramedics, Laura, Rhys Tom & Katie for skydiving in aid of @EastAngliAirAmb An experience you'll never forget! Still time to visit their just giving page https://www.justgiving.com/companyteams/LEAAP-ersPeter Bowles @wmaspeterbowlesRumour has it you might catch a few clips of myself and some of the other members of @WMASHART on tonight's episode of #Ambulance on @BBC at 9pm.

Packing an academic punch

Three Key TakeawaysThis book explores many aspects of disaster psychiatry in a readable format and consistently supported by a large bank of evidence.The supporting graphics appear fairly infrequently so you can often be presented with page after page of text. Despite this, it really is quite easy to read and you don't find yourself bogged down with science.This book should feature in the library of every ambulance service resilience department and should not gather dust.

Using haemostats effectively in pre-hospital care

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. Here, Rory McKelvin discusses haemostats; what they are, how they work, when and where to use them, and how to do so effectively.

Secondary traumatic stress and resilience among EMS

Aim:The current study investigated the positive and negative psychological adaptations that are a result of secondary traumatic stress, and the role of resilience among paramedics and emergency medical technicians (EMTs).Methods:Emergency medical service (EMS) providers anonymously completed four validated questionnaires on: secondary traumatic stress, post-traumatic growth, resilience, and changes in outlook. Relationships between these constructs and demographics were explored.Findings:Overall, EMS participants reported a higher-than-average positive change in outlook. Resilience (p<0.001) was significantly inversely related to secondary traumatic stress and negative change in outlook. EMS working part-time demonstrated a significantly higher level of resilience (p=0.005) compared with full-time. Post-traumatic growth was significantly higher (p=0.03) in EMTs compared with paramedics. No significant differences (p>0.05) were detected between years of experience for any attributes analysed.Conclusion:Findings demonstrated significant correlations between secondary traumatic stress, resilience, post-traumatic growth, and changes in outlook in EMTs and paramedics.

Care pathways for low-risk transient ischaemic attack

Background:In secondary care, the urgency of review for transient ischaemic attack (TIA) has relied upon the use of the ABCD2 score, but this tool is not validated for use by emergency ambulance crews. There is a need to evaluate alternative care pathways for patients who might be eligible for direct referral to TIA clinics without prior conveyance to the emergency department (ED).Aim:The aim of this national survey was to describe current service provision across the UK for pre-hospital emergency care of patients with TIA.Methods:The authors approached all UK Ambulance trusts (n=13) by email, asking them to provide details of TIA patient referral pathways.Findings:Twelve ambulance services responded to the survey and nine reported that they had no current pathway; one had discontinued a pathway because of service reconfiguration; and three were currently using one. All pathways used the ABCD2 tool to screen patients and classified patients as low-risk if the ABCD2 score was 3 or below. Non-conveyance exclusion criteria varied. Although compliance with referral pathways was audited in an initial pilot in one service, no other evaluations of the effectiveness of pathways were reported.Conclusion:A minority of UK ambulance services report introducing referral pathways for low-risk TIA patients, avoiding initial assessment in the ED. Safety, effectiveness and acceptability of such pathways have not been evaluated to date.

Hand hygiene compliance in the pre-hospital setting

Health professionals' compliance with hand hygiene remains a universal problem in health care. While poor hand hygiene is prevalent in the inpatient and hospital environments, these behaviours are also similar among emergency medical services (EMS) personnel. Studies in infection prevention and control practices and knowledge of transmission of the spread of multidrug-resistant organisms within the EMS have highlighted sub-optimal standards and a need for improvement. This article discusses the different products, procedures and strategies available to improve hand hygiene compliance in the EMS, and how applying learning theories to understand and improve behaviour can also be incorporated into the crusade to improve hand hygiene.

Prescribing laws mark new era for paramedic profession

In this article, Alistair Quaile discusses the steps up until now that have been taken to achieve independent paramedic prescribing and explores the impact this ability may have on improving the quality of patient care.

JPP Letter

Dear Dr T Mallinson, Thank you for your kind words regarding my article, and the additional points you have provided.

JPP Letters

Laws of LightFirstly, it is useful to recognise that the functionality of pulse oximeter technology (and indeed many arterial blood gas analysers and other laboratory equipment) relies upon the Beer-Lambert Law, which states that; The absorbance of light/radiation is proportional to the concentration (or density) of the tissue through which it passes, and to the distance the light/radiation must travel through.

Like it or not, you are a superhero…

Aysha Mendes

End of life care in the community: the role of ambulance clinicians

OverviewAmbulance clinicians are frequently called to patients who are approaching the end of their life. This article presents an overview of some of the issues that impact on the delivery of care to patients at the end of life, including symptom and urgent care needs in the last few days of life; preferences for care/place of care; and coordination of care. Each of these areas pose different challenges for ambulance clinicians. As a way of addressing some of the issues, this article outlines an online education package in end-of-life care, which has been specifically designed for ambulance clinicians in response to an analysis of their training needs. The learning outcomes and educational approach is described. The education aims to help equip ambulance clinicians with the knowledge and confidence that they need to deliver high-quality urgent end-of-life care.