Volume 11 Issue 10

From Casualty to A&E: a pleasant surprise

After first training as an actor and being strongly influenced by the images of paramedicine depicted on television, 2nd year student paramedic, Jolyon Price, shares his preconceptions about paramedicine and the reality he is now discovering

Salutogenesis: the case for a holistic tool for paramedic assessment of wellness

Sense of coherence (SOC), the capacity to muster, believe in and value resources to support resilience, is a central component of the salutogenic approach to wellness. Assessing patients' SOC in a salutogenic model may be useful to paramedics as an adjunct to effective referral to care pathways other than via the emergency department and for predicting patient engagement. A tool to help direct practitioners in the prehospital environment towards the most appropriate resources for each patient's unique situation appears to be lacking. This article examines the literature around salutogenic and SOC theories and provides an overview of how a salutogenic assessment tool could be used in paramedic practice. Taking a multifactorial approach to determining health status and predicating patient capacity for adaptive coping may make health professionals better able to assist patients in overcoming health events and build health resilience to improve their future health outcomes.

Clinical decision making and the challenges of responding to mental health needs

The paramedic service responds to emergency calls for a variety of reasons, many relating to mental health concerns. This qualitative study aims to explore the views and experiences of student paramedics in relation to clinical decision making for mental health calls. Focus groups were used to investigate the participants' perspectives. Thematic analysis was used to organise data and identify key issues. Findings suggested some disparity between what paramedic students were prepared for and the reality of public need. Clinical decision making in relation to those with mental health problems was significantly influenced by the current provision of mental health services and the lack of mental health-specific education for student paramedics. Current changes to the paramedic programme make this an opportune time for a review of curriculum content.

Taking a holistic approach to acute mental health crisis

An innovative, collaborative model implemented by a UK ambulance service allows patients presenting with a mental health condition to be promptly assisted by a specialist team comprising a paramedic, mental health nurse and police officer. Initial evidence suggests that greater collaboration between emergency services and mental health trusts benefits patients and services: leading to timely assessments, reductions in patient distress levels, and decreasing emergency department overcrowding while providing substantial savings for the NHS. This article explores existing care pathways for patients experiencing acute mental health crisis. Current research from the UK is discussed, and compared with working practices of paramedics internationally. Through reflection of a case study, common difficulties faced in paramedic practice are identified. A multi-agency response to ensure the right care is provided in the right place at the right time is proposed.

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