Prehospital use of supplemental oxygen therapy in the non-hypoxic patient

Supplemental oxygen therapy in the prehospital setting can be life saving in the treatment of hypoxaemia. However, it is often administered liberally in a routine manner without clinical indication. In hyperoxaemia, it is associated with a higher risk of morbidity and mortality in acutely ill patients. An audit was performed on the use of supplemental oxygen therapy in the Irish ambulance service, which looked at: reasons for ambulance transfer; delivery device used to administer supplemental oxygen; oxygen saturation levels before and after therapy; and level of the practitioner giving the treatment. The audit results were screened against formal international guidelines, and recommendations were made to improve practice, with a view to re-auditing in the future.

The myth of ‘helpful fear’

Taking their first steps as student paramedics

In this special education issue of the Journal of Paramedic Practice, we hear from three students who have just started their journey into paramedic education at Edge Hill University. Lily Springett, who feels like she's in a game of snakes and ladders, Katy Sofield, who finds herself in a whirlwind of anatomy, skills and theory, and Laura Pilling, who is preparing her thermal socks and sweets for placement, offer three diverse perspectives on what it has been like to take their first steps as student paramedics

Facing fear and embracing change

With the unpredictable nature of the work of a paramedic, Abbygail Elsey looks back on her first year as a Newly Qualified Paramedic and realises that perhaps the only constant is change, and the only way to approach the fear of change is to face it and embrace it

A paramedic journey to non-medical prescribing: part 3

Will the winter of 2019/20 have unusually high service demand? Part 2: Strategy

A human rights perspective on the use of social media by the ambulance services

Social media use on behalf of ambulance services by paramedics, student paramedics and ancillary staff—‘corporate tweeting’, as it has become known—has in recent times been the subject of much debate in the paramedic profession. It has been argued that social media use is an unstoppable tide and a necessary means of imparting information to members of the public about the work the ambulance service performs. Conversely, others have argued that by tweeting about their patients, the ambulance service is breaching a fundamental code of professional ethics due to the use of confidential patient data. This article explores the UK legal framework of privacy and confidence in the healthcare context, from a human rights perspective, and seeks to demonstrate that some corporate tweeting has breached not only ethical standards, but may also have crossed the line into unlawfulness owing to the public nature of the organisations involved, and their legal duty to protect the human rights of their service users.

Application of pelvic binders by student paramedics: an observational cohort study

Background: Pelvic fractures occur in approximately 20% of all multi-system traumas and can lead to loss of life through exsanguination. Advanced Trauma Life Support (ATLS) guidelines advocate application of a pelvic binder, which is most effective when placed at the level of the greater trochanters; however, multiple studies demonstrate a high degree of misplacement. Aims: The aim of the current study was to assess the ability of UK student paramedics to locate the greater trochanters and optimally apply pelvic binders. Methods: A total of 52 student paramedics from UK universities were asked to apply a pelvic binder to a healthy volunteer using a recognised technique. The primary outcome was the location of the pelvic binder compared with an optimally applied device. Findings: <i>n</i>=52 with 17/49 pelvic binders incorrectly located (34%); 18% were too low and 16% were too high. Conclusion: The results demonstrate a high degree of misplacement; this represents both a challenge and an opportunity for UK higher education institutions to review the manner in which pelvic binder application is taught to the next generation of prehospital practitioners.

Student paramedics' views on placements in general practice as part of a degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

Road resilience: adaptive education for emerging challenges

The reality of paramedicine can cause students emotional distress, especially if this tests their values or beliefs. Therefore, educating students to be resilient and prepared for unpredictable, distressing events should be considered. The need to increase professional longevity in paramedicine has shifted employers' focus from road readiness to road resilience, which presents a complex challenge for educators. This article is the first of a series to discuss the use of supporting sciences to build road resilience in undergraduate paramedicine programmes. A review of the literature on paramedic education demonstrates there is new knowledge, based on experience in clinical practice and research, that paramedic educators can draw on to develop their discipline. Paramedics with postgraduate qualifications can shape the future of their professional discipline when their research produces a new discourse that informs a curriculum which can meet contemporary challenges. Discussion of a fictional case study illustrates how an emotional crisis could provide a platform for reflective learning and make a student more effective as a paramedic, and the educational environment needed to facilitate this.

Overcoming the barrier of stigma

The Caladrius (1200–1300)

Thirteenth century paintings from the libraries of Sir Hans Sloane (1660–1753) and Robert Harley (1661–1724).