Volume 11 Issue 3
Management of cardiogenic shock complicating ST-segment elevation myocardial infarction: part 2
Cardiogenic shock is a leading cause of death in those experiencing ST-segment elevation myocardial infarction. The objective of therapeutic strategies is to preserve end-organ perfusion and reduce mortality. Prompt revascularisation by percutaneous coronary intervention or coronary artery bypass graft is considered the gold standard of care. Pharmacological and mechanical support is indicated in patients with persistent hypotension and evidence of end-organ hypoperfusion. However, there is a paucity of scientiĉ data regarding the best pharmacological agent or form of mechanical support. Prehospital care has a pivotal role in caring for these patients by monitoring them and providing physical and psychological support during transfer to acute care. Palliative care is complementary to curative therapies and should be perceived as integral to effective symptom management.
Use of dark humour as a coping mechanism
This month, Ellie Daubney shares the first time she witnessed the use of dark humour on placement in the ambulance service and how her feelings towards it have since evolved
Home visits from paramedic practitioners in general practice: patient perceptions
Background: As set out in the General Practice Forward View (NHS England, 2016), the success of general practice will rely on new ways of working, including having a multidisciplinary workforce. The role of the paramedic practitioner (PP) working within a GP surgery was proposed in a report by the Primary Care Workforce Commission (<xref ref-type="bibr" rid="B12">Health Education England, 2015</xref>). The role involves PPs having their own clinics within the GP surgery, managing a variety of presenting complaints, as well as conducting urgent home visits to assist with GP workload. However, what are patients' perceptions of being attended to by the PP in place of the GP? Aim: To explore older patients' perceptions of having PPs, who work in GP surgeries, attend to them on a home visit in place of the GP. Method: A qualitative study using face-to-face, semi-structured interviews, with thematic analysis. Findings: There is confusion regarding the role of the PP, with a strong desire to be informed more about it. However, despite this confusion, there is a positive perception among older patients of having a PP attend to them on a home visit in place of the GP. The patients felt that the PP managed their complaints well, and was equipped with the required skills and knowledge. Conclusion: Information needs to be provided to the public to increase awareness of the PP role. The role of the paramedic is changing; however, there is little published research investigating the contribution of paramedics working in primary care. This pilot study serves to highlight areas that require further investigation on the influence of the PP in general practice.
Point-of-care blood tests in decision-making for people over 65 with acute frailty
Background: National ‘see, treat and discharge’ rates for paramedics have increased. However, despite the rise in demand on paramedic decision-making, there have been few improvements to prehospital diagnostics. Patients aged over 65 years presenting with acute frailty syndromes are a notably complex clinical patient group for whom informed risk stratification in clinical reasoning is paramount. Methods: This was a single-site quality improvement project using point-of-care blood testing (POCbT) to help inform decision-making for patients aged above 65 years with acute frailty syndromes. Results: This quality improvement project showed a self-reported improved confidence in clinician decision-making and patient disposition with the use of POCbT. This confidence was validated by improved discharge on scene and recontact rates. An unintended outcome of the project was the accumulation of practical knowledge on the use of POCbT in the prehospital arena. Conclusion: Continued use of POCbT in the prehospital environment has promise but this is not without limitations. Prehospital services wishing to implement POCbT should focus on demographic identification, staff training and interpretation of results.
What is the paramedic's role in smoking cessation?
Background: Both the National Institute for Health and Care Excellence (NICE) and Public Health England have made smoking cessation a health promotion priority but the paramedic's potential impact in this important area has yet to be fully realised. Aim: This article proposes an evidence-based quality improvement intervention that can be adopted by paramedics at an individual, service-wide or national level to promote smoking cessation. Methodology: Building on a structured literature review and using the three fundamental questions and a Plan Do Study Act cycle, we propose a quality improvement strategy and evaluation methodology suited to the aims of the article. Discussion: Very Brief Advice is an evidence-based, effective and time-efficient way of reducing harm from smoking and improving quality of life for patients, saving NHS money as well as increasing paramedic job satisfaction.