Volume 10 Issue 8

A brief guide to borderline personality disorder in an emergency setting

OverviewParamedics and ambulance staff are frequently in contact with patients who have mental health diagnoses This may be the primary reason for contacting the emergency services (e.g. self-harm, crisis or suicide ideation) or it may be incidental to their primary clinical concern. Patients in mental health crisis can be challenging and demanding. Most paramedics will not have had specific guidance on identifying or understanding the features, aetiology and responses to treatment of patients with a diagnosis of borderline personality disorder. Borderline personality disorder is associated with a high risk of self-harm, risk-taking behaviour and suicide. Building a rapport with patients is often crucial to paramedics achieving optimum patient care. There are features of borderline personality disorder that may make rapport-building more complex, and the establishment of trust harder for the clinician to achieve and maintain. There is potential for frustration and a lack of understanding to interfere with the successful delivery of person-centred care. In order to support patients with borderline personality disorder, ambulance staff need to be aware of the particular characteristics of this condition and the current best practice guidance.

Remembering Malcolm Woollard

It was with real sadness and regret that I learnt of the untimely death of Professor Malcolm Woollard last month. Sadness that a friend and mentor had died far too early, and regret that the projects we had been developing will now have to continue without his presence, insight and guidance. Malcolm's achievements are unparalleled in the context of the paramedic profession, and it is reasonable to argue that he has been one of the most influential people in the development of the paramedic workforce in recent years.

JPP Letters

Deborah BeardsParamedic, North West Ambulance Service, East Cheshire.Are YOU a HERO? Published in the June edition of All Together Great Staff Newsletter, NWAS By Deborah Beards

Worthy of your shelf space

Three Key TakeawaysIn-depth information of a complex topic that is clearly and concisely written is providedEach chapter is progressively structured with excellent use of diagrams to aid quick referencingThis book it suitable for a wide range of readers from those needing a basic overview to those whose role it is to manage major incidents


What are paramedics tweeting about?Paramedic Practice @Para_PracticeThe government is proposing to teach all children in England first aid—including #CPR and life-saving skills. This is positive news for #paramedics—bystander intervention can improve clinical outcomes for certain conditions.@BritishParamed1Who are they going to get in to teach it, or are the teachers going to be doing it?@scott_goudieThis is the same government that talked until an identical bill ran out of time to be heard in the commons a little while back? Now it's their idea eh?Jules Lockett @juleslockett06okay I'm supporting the amazing @Kharrison50Katy @Ldn_Ambulance supporting #YouthAmbassadors & talking about all things #MentalHealthVinny Romano @NWAmb_VinnySpent the day completing a contact shift with one of my SPTLs. Attended an RTC and went through some airway techniques. #leadershipJoel Phillips @joelparamedicEarlier this year, Bristol Live reported on shocking figures showing 99.7 per cent of assaults on ambulance staff in the South West did not result in prison for the offender. That's one person out of 300.Ryan Douglas @ryandouglas412Yes, you may use your phone, it does not interfere with our onboard equipment. We do, however, require seatbelts for takeoff, accept hand luggage only, have inflight oxygen available and can, at busy times like tonight, be subject to minor delays #FlySASKarl Williams @WmasKarlWThe more people we can get sharing this the better. It's important to know that any CPR is better than no CPR! We will never tell you off for doing it! I'm willing to answer and questions around this subject tonight so if you have questions please get in touch #LearnCPR.

Understanding an alternative approach to paramedic leadership

OverviewLeadership is an essential feature of the life of a paramedic. During incidents, while working with multi-agency colleagues, and within organisations, leadership is an expected quality for paramedics to have. Across health and social care organisations, leadership is said to be of pivotal importance to future success. This has led to a large investment in leadership development programmes that organisations are now seeking to justify. Leadership, as a concept however, is complex and multifaceted. The nature of leadership has been debated over millennia and disagreement remains as to how to define it. The current article uses Critical Interpretive Synthesis to consider how approaches to leadership have developed over time. It concludes with a synthesising argument that leadership is a social construct; as such, no single definition will ever be appropriate. However, the four elements that comprise the leadership equation should be considered if the paramedic leader is to be effective.

Cutting my safety line

In this month's student column, Abbygail Elsey describes the exciting and nerve-racking experience of leaving the student life behind for the beginning of a career as a newly qualified paramedic

Measuring blood pressure and monitoring patterns

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, Sally Thompson discusses the importance of monitoring blood pressure trends in acutely ill or injured patients

A prehospital focus on rhabdomyolysis in elderly falls

More than a quarter of ambulance call-outs relate to elderly falls. Immobility following a fall can cause muscle to break down which can lead to rhabdomyolysis—a life-threatening condition that can be easily overlooked in pre-hospital care. Samantha Murdoch argues the need for training and education around this lesser-known condition

Student paramedic views of an international clinical and cultural learning experience

Background:Universities are now frequently exploring international placements and learning experiences for paramedicine students. This has given rise to questions about the quality and meaningfulness of overseas student experiences within the paramedic curriculum.Aim:This study investigates whether a university-organised overseas trip provided a useful clinical and cultural learning experience for undergraduate paramedicine students.Methods:A 60-question survey was administered to participants, with questions chiefly focusing on clinical and cultural experiences during the overseas trip. Statistical software was used to analyse continuous and categorical survey data.Findings:This international trip appears to have provided a very useful cultural learning experience, but a sub-optimal clinical learning experience for students (even despite child births, emergency room presentations and blood-draws).Conclusions:A validated survey instrument which builds upon current knowledge and literature could be used more widely to evaluate and better understand the dimensions of quality in overseas paramedic student placements.

Death notification delivery and training methods

For a paramedic, delivering a death notification (DN) is one of the most difficult and stressful messages they will have to communicate in practice. Stress and anxiety in both recipients and paramedics have been documented through a limited literature base. The current review seeks to understand the existing educational tools and training around DN, and evaluates the applicability of these in the pre-hospital environment.

Point-of-care ultrasound use in the pre-hospital setting

In the pre-hospital setting, point-of-care ultrasound (POCUS) is a useful diagnostic tool that can provide additional clinical information to assist with pre-hospital management strategies and choice of hospital destination. Studies describing the clinical utility of paramedic-performed POCUS in the pre-hospital setting are lacking; however with the right training and education, paramedics are able to adequately obtain high-quality ultrasound images. Despite this, education programmes vary widely and a standardised approach is yet to be defined. The technology of ultrasound devices continues to evolve and in future, the transmission of ultrasound images to the receiving hospital should be a minimum requirement. While some studies report that POCUS influences pre-hospital management, data are lacking as to whether this improves patient outcomes. The authors have demonstrated the potentially significant role of POCUS in pre-hospital care; however this assessment modality does not replace physical examination, clinical experience and clinical decision-making.

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