Volume 11 Issue 5

Clinical decision-making and its place in paramedic practice

In the prehospital environment, paramedics are required to make clinical decisions, often rapidly to ensure correct treatment and care is provided. Decisions made by paramedics majorly impacts on the life, clinical outcome, safety, health and wellbeing of their patients. With the introduction of the Newly Qualified Paramedic Framework, it potentially has never been more pertinent to examine the decision-making process-an integral part of paramedicine.The implementation of the NQP framework has prompted an exploration into clinical decision making and its place in an ever-evolving profession. Through examination of theories and frameworks, this article aims to identify the underpinning evidence that enables a paramedic to reach a competent decision and the barriers experienced in the process.

Our role in a family's crumbling world

Newly qualified paramedic at South Central Ambulance Service, Abbygail Elsey, shares a personal experience of loss and provides a reminder of just how much a paramedic's role matters to the families who call you to the scene of their loved one's death

Pioneering end-of-life care at London Ambulance Service

In recognition of the important role of the paramedic in end-of-life care and to coincide with Dying Matters Awareness Week from 13–19 May, the London Ambulance Service shares some insight into the end-of-life care strand of their pioneer services in this Question and Answer feature.

Attitudes and perceptions of paramedics about end-of-life care: a literature review

Background: Paramedics must be prepared to respond to crises in which a threat to a patient's health may result in death. They are therefore highly involved with end-of-life care. Aims: Involvement with end-of-life care is the context in which this paper examines how paramedics perceive and respond to this part of their role. Methods: This is a systematic literature review that examines current evidence. Findings: Five themes emerged, which suggest that paramedics are not prepared to work with crisis situations involving the end of patients' lives: emotional resilience; decision making; communicating death; recognising dying patients; and death education. Conclusion: The current review concludes that the dearth of data is not preventing improvements in services, nor education and training, in this field.

Managing common end-of-life cancer presentations according to the evidence

The ambulance service is increasingly being called to patients suffering from cancer who are near the end of their lives. This presents challenges to clinicians who may not be confident in the management of symptoms near the end of life. The approach to, and management of, these types of patients often requires different considerations to more traditional emergency calls. This article reviews the evidence around the management of common cancer presentations at the end of life. In particular, it will consider the psychological effects of a terminal diagnosis, management of breakthrough pain, breathlessness and neutropenic sepsis.

‘Do not attempt CPR’ in the community: the experience of ambulance clinicians

Background: Ambulance clinicians must make time-critical decisions concerning treatment and resuscitation. Little is known about the impact of the presence (or absence) of do-not-attempt cardiopulmonary resuscitation (DNACPR) decision forms in the community. Aims: To investigate ambulance clinicians' experiences of DNACPR documentation and views concerning potential future changes. Methods: This multi-methods study used semi-structured face-to-face interviews (<i>n</i>=10) and an online questionnaire (<i>n</i>=123) Findings: Ambulance clinicians report that a statistically significant increase in numbers of community DNACPR forms has occurred in recent years. Most state they have not had formal DNACPR education and experience difficulties in making clinical judgments about patients at the end of life, reporting inappropriate CPR attempts and poor communication among stakeholders. Conclusion: Assessment of patients near the end of life with (and especially without) a DNACPR is challenging for ambulance clinicians. Education about resuscitation recommendations needs to be integrated into training and a national approach should be taken to decisions and their documentation.

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