Volume 10 Issue 9

Discerning the age of a child

In this comment, Gregory Whitley and Bill Lord note the disparity in age ranges used to define a ‘child’, across both clinical guidelines and research, and its significant implications for paramedic practice

Adult intraosseous access: a comparison of devices

Background:Evidence to support device choice in intraosseous access is lacking in UK paramedic practice. Being unable to access the sternum with devices may result in under-treatment because of the inability to gain timely vascular access. This represents a shortcoming in current practice and a need for further research.Method:A literature review was conducted to find suitable studies and these were critically appraised. The data were synthesised to draw conclusions that could either influence practice or inform research. Study results were analysed in order to examine the following outcomes for devices most successful in terms of insertion rates; insertion times; ease of use; and flow rates. Cost-efficacy was also taken into consideration.Results:Forty-eight relevant articles were identified in the search and 18 were analysed. Of the 18 articles, 7 were randomised controlled trials and 11 were observational studies. Results varied widely with differences in reporting making the synthesis of data problematic. However, there was sufficient evidence to conclude that semi-automatic devices are superior to manual ones.Conclusion:Weaknesses in the evidence and inconsistencies between studies limited the conclusions that could be drawn. There is a strong mandate here for further research.

Hyperventilation syndrome: diagnosis and reassurance

This article provides an overview of hyperventilation syndrome (HVS). Hyperventilation is to breathe in excess of metabolic requirements; in the absence of an underlying organic cause, it is defined as HVS. Alternative terms used in literature are panic or anxiety attack, panic or anxiety disorder, dysfunctional breathing and breathing pattern disorder. This article explores HVS signs and symptoms beyond the familiar clinical signposts of tachypnoea, chest tightness, paraesthesia and anxiety. It will also discuss differential diagnoses and pre-hospital treatment of HVS, focusing on reassuring patients and assisting them in establishing a good respiratory pattern. Patients with HVS use a significant amount of hospital and emergency service resources, ideally placing paramedics to diagnose and treat HVS in the pre-hospital setting to avoid unnecessary and costly hospital admissions. Further research is needed to evaluate the pre-hospital prevalence and diagnostic accuracy of HVS, identify clear diagnostic criteria and design screening tools.

How does your job impact your health?

A subscriber to JPP emailed me this summer wanting to cancel her subscription after having to remove herself from the Health and Care Professions Council (HCPC) register—she said she had recognised that remaining in the paramedic profession was detrimental to her mental health. She wrote of her disappointment to be cancelling her subscription, and of her grief to be leaving the profession she loves.

Air transport and beyond

National Air Ambulance Week takes place from 8–16 September. In this short comment, Steve Dick, Critical Care Paramedic from Derbyshire, Leicestershire and Rutland Air Ambulance, discusses how air ambulances have moved beyond air transport to critical care delivery, exposing paramedic crew members to increasingly advanced and complex skills in support of their land-based colleagues.

A look at discussions on JPP's social media

What are paramedics tweeting about?Paramedic Practice @Para_PracticeIt seems every week there's another story about abusive notes left on #ambulances. While this is clearly unacceptable, do you think more attention should be paid to physical or verbal #abuse?@TommyA83I'm not really sure what in this note constitutes ‘abuse’? Perhaps engage with the person directly rather than sensationalise it on here!@dkcblainShould this be considered under the malicious communications act?Katie Tudor @wmaskatietudorWhen control call you and say “I need you to make your way to this location ASAP, we have a patient giving birth in her car” On our arrival, baby had been born and we had the pleasure of wishing her Happy Birthday!! Mum and baby both doing well #bestjobintheworldJon Price @NWAmb_JonGreat to hear a Cardiac Arrest Survivor was able to meet the staff who saved her life and thank them in person with her family! #thisiswhywedowhatwedoEd Hill @EdHill0What a night, but very proud to be a part of the SC. Even if I did miss my own briefing because I had one in cuffs! Goes to prove how adaptable the SC are, proactive policing, managing demand and reassuring the public. Proud!London Ambulance @Ldn_AmbulanceWe've teamed up with taxi drivers to train cabbies to help save the lives of cardiac arrest patients in the capital.Joel Phillips @joelparamedicFirst qualitative interview conducted for my primary research, with more booked in. It's all slowly coming together. The final paper on ‘Paramedic views of NHS 111’ should be an interesting read! #nhs111 #paramedic #PHEM #paramedicResearch

The time is right to make decisions with confidence

Three Key TakeawaysIt is the right time for this book, mainly as a result of the rapidly changing epidemiologic context of our time and the fact that patient complexity is increasing—ultimately requiring the paramedic to be able to treat and discharge at sceneThere are terms and phrases you may have come across before, however, there is a good reason for this reiteration, which is that they are true and paramedics should consider themDespite not being a clinically-focused book, the included case studies hold some interesting and thought-provoking clinical aspects

Becoming an autonomous practitioner

In this month's student column, Ellie Daubney describes the necessity of learning how to make decisions independently while out on placement and when studying at university

Recognising ECG landmarks

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 instalment, Karen Simpson-Scott takes an in-depth look at electrocardiograms and the vital readings they provide for clinicians

Role of the new HEMS Development Manager at AAA

In this first instalment of regular contributions from the Association of Air Ambulances, new HEMS Development Manager and JPP Editorial Board Member, Becky Steele, shares the ins and outs of her role.

A qualitative exploration of current paramedic cardiac auscultation practices

This exploratory study addresses the current paucity of knowledge available in UK paramedic practice in relation to cardiac auscultation. There is a recognised lack of data surrounding the efficacy, safety and relevance of patient assessment skills in the pre-hospital setting in general, and cardiac auscultation specifically. This study provides information about current paramedic practice, and provides a basis for further research in this area. An online survey was distributed using convenience and snowball sampling, receiving 328 responses within a 31-day period. The results show that many paramedics rarely, or indeed never, undertake cardiac auscultation and that many lack confidence in recognising normal and abnormal heart sounds. There is also a divided opinion among respondents who provided free-text answers, with some feeling that the skill of cardiac auscultation is vital in pre-hospital care and others firmly disagreeing. This research lays the groundwork for further developments in training, education and continuing professional development for paramedics.

Advanced care planning in end-of-life care: the key role of ambulance services

OverviewEffective communication and coordination between individual care providers is vitally important to ensure that patients' wishes are respected throughout their care and when they die, as well as that families and loved ones are supported following the patient's death. Ambulance services play an increasingly key role in end-of-life care and this is especially true in terms of transfer of the dying patient (NEoLCP, 2012). This month's continuing professional development (CPD) article will explore advanced care planning and, in particular, it will focus on do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, advanced decisions to refuse treatment (ADRTs) and rapid discharge transfers.

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