Only weeks into his education as a student paramedic, Samuel Parry joins us as our new first-year columnist, sharing his journey up to starting, where he is now, and what lies ahead
Attaching a different or using no extension set with intraosseous (IO) needles may affect the time taken to administer fluid. An in-vitro study measured this effect.
Three methods of administration were examined (10 experiments for each approach): a fluid-giving set directly placed in the IO needle hub (direct-to-hub: DTH); a fluid-giving set connected to the EZ-IO device extension set (EZ set: EZS); and a fluid-giving set connected to a simple three-way extension set (three-way set: TWS).
Mean times for administration were 317 s for DTH (SD=15 s), 322 s for TWS (SD=8 s) and 361 s for EZS (SD=19 s). This demonstrated a significant difference between the three groups (ANOVA significance <i>p</i><0.0001).
It may be possible for clinicians to increase IO flow rates by removing or replacing the extension set that is supplied with the EZ-IO needle set.
Overall, neonatal mortality has been shown to be reduced by: placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth); delayed cord clamping (DCM) (waiting for the umbilical cord to stop pulsating before clamping and cutting the cord); and umbilical cord milking (UCM) (clamping and cutting the cord immediately before milking the cord towards the neonate to expel remaining volume). This systematic review aimed to determine whether placental transfusion negatively impacts resuscitation by delaying it or has any effect on infant mortality, and to identify any barriers to performing it.
CINAHL, MEDLINE, AMED and the British Nursing Index were searched using key terms to identify relevant English language publications between 2017 and 2019.
Five papers were selected for critical analysis—three randomised control trials and two cohort studies.
Placental transfusion was not found to have a negative impact on neonatal resuscitation but, equally, had no significant effect on Apgar at 5 minutes; however, Apgar is a crude measure of infant mortality. The question remains around the proven multifaceted benefit of placental transfusion in the prehospital environment, which requires further research. There is evidence to suggest prehospital clinicians should be looking to change practice. Further research, considerations and consultations are required to ascertain the best way to implement the procedure with a balanced and proportionate approach considering neonatal thermoregulation and maternal management. The main reported barrier to placental transfusion was a lack of appropriate equipment.
Paramedics are the primary providers of prehospital care to children in an emergency. However, they deal with children's emergencies infrequently, and consistently report a lack of confidence in this area. The Royal College of Paediatrics and Child Health standards state that clinicians with Advanced Paediatric Life Support (APLS) training or equivalent must be available at all times to deal with emergencies involving children. While APLS is widely recognised as the gold standard in paediatric training, it focuses on in-hospital providers of paediatric life support, so may not adequately meet the needs of prehospital providers. The Paramedic Advanced Resuscitation of Children (PARC) course attempts to condense the most important aspects of APLS for paramedics into a simulation-based programme that is practical and cost effective. Evaluation of the views of the eight paramedics who took part in the pilot revealed that they felt more confident in managing children's emergencies after attending the course. The PARC course may be a simple, cost-effective method to improve paramedics’ confidence in dealing with emergencies involving children.